S.Amdt. 2024

1. Rewrites section 105

   Replaces

   In S. 1789 · Reported to Senate

   Struck: SEC. 105. ARBITRATION; LABOR DISPUTES.

   Inserted: SEC. 105. ENROLLING SENIORS IN THE SAME HEALTH CARE PLANS AS MEMBERS OF CONGRESS.

   [struck: Section 1207]([struck: c][inserted: a])[struck: (2) ][inserted: In General.--Chapter 89 ]of title [struck: 39][inserted: 5], United States Code, is amended--

   Struck: (1) by inserting "(A)" after "(2)";

   Struck: (2) by striking the last sentence and inserting "The arbitration board shall render a decision not later than 45 days after the date of its appointment."; and

   Struck: (3) by adding at the end the following:

   Struck: "(B) In rendering a decision under this paragraph, the arbitration board shall consider such relevant factors as--

   Show 3 more struck paragraphsShow less

   Struck: "(i) the financial condition of the Postal Service;

   Struck: "(ii) the requirements relating to pay and compensation comparability under section 1003(a); and

   Struck: "(iii) the policies of this title.".

   Inserted: (1) in section 8901--

   Inserted: (A) in paragraph (10), by striking "and" at the end;

   Inserted: (B) in paragraph (11), by striking the period at the end and inserting "; and"; and

   Inserted: (C) by adding at the end the following:

   Inserted: "(12) the term 'covered individual' means an individual who, taking into account section 226(k) of the Social Security Act, would have been entitled to, or could have enrolled for, benefits under part A of title XVIII of such Act or could have enrolled under part B of such title if section 1899B had not been enacted.";

   Inserted: (2) by inserting after section 8901 the following:

   Inserted: "SUBCHAPTER I--FEDERAL EMPLOYEES";

   Inserted: (3) in section 8902--

   Inserted: (A) in subsection (a)--

   Inserted: (i) by inserting "(1)" after "(a)"; and

   Inserted: (ii) by adding at the end the following:

   Inserted: "(2)(A) In this paragraph, the term 'equivalent health benefits plan' means a health benefits plan proposed to be provided that offers benefits that the Director of the Office of Personnel Management determines are substantially equivalent or superior to benefits offered under, and does not impose requirements that are substantially different than requirements under, a health benefits plan in which an employee could enroll on the date of enactment of this paragraph if the employee resided--

   Show 107 more inserted paragraphsShow less

   Inserted: "(i) anywhere in the United States; or

   Inserted: "(ii) in the same region of the United States as the health benefits plan proposed to be provided.

   Inserted: "(B) For contract years beginning on or after January 1, 2014, if a carrier offers to provide an equivalent health benefits plan, the Director shall enter into a contract with the carrier to provide the equivalent health benefits plan.";

   Inserted: (B) in subsection (e), by striking "The Office may prescribe" and inserting "Subject to subsection (a)(2), the Office may prescribe"; and

   Inserted: (C) by adding at the end the following:

   Inserted: "(p) A contract under this chapter for a contract year beginning on or after January 1, 2014, shall offer benefits for employees, annuitants, members of their families, former spouses, persons having continued coverage under section 8905a of this title, and covered individuals. In administering this subchapter and subchapter II, employees, annuitants, members of their families, former spouses, persons having continued coverage under section 8905a of this title, and covered individuals shall be in the same risk pool.";

   Inserted: (4) in section 8904--

   Inserted: (A) by striking "(a) The benefits" and inserting "The benefits";

   Inserted: (B) by striking "this subsection" each place it appears and inserting "this section"; and

   Inserted: (C) by striking subsection (b);

   Inserted: (5) in section 8909(a)(1), by inserting "and for all payments under section 8921(d)" before the semicolon;

   Inserted: (6) in section 8910, by striking subsection (d); and

   Inserted: (7) by adding at the end the following:

   Inserted: "SUBCHAPTER II--COVERED INDIVIDUALS

   Inserted: "Sec. 8921. Health insurance for covered individuals

   Inserted: "(a) For contract years beginning on or after January 1, 2014, and except as otherwise provided in this subchapter, the Director of the Office of Personnel Management shall ensure that to the greatest extent possible health benefits plans provide benefits for covered individuals to the same extent and in the same manner as provided under subchapter I for employees, annuitants, members of their families, former spouses, and persons having continued coverage under section 8905a of this title.

   Inserted: "(b)(1) The Director shall establish the deadline by which a covered individual shall elect to--

   Inserted: "(A) enroll in a health benefits plan under this chapter based on the status of the individual as a covered individual;

   Inserted: "(B) with the concurrence of the employer or former employer of the covered individual, receive payments under subsection (d) to assist in paying for health insurance provided through the employer or former employer of the covered individual; or

   Inserted: "(C) not enroll in a health benefits plan or receive payments under this chapter.

   Inserted: "(2) Failure to make a timely election under this subsection shall be deemed as an election to not enroll in a health benefits plan or receive payment under this chapter.

   Inserted: "(3) A covered individual--

   Inserted: "(A) may elect to enroll in a health benefits plan as an individual; and

   Inserted: "(B) may not enroll in a health benefits plan for self and family.

   Inserted: "(4)(A) A covered individual who elects not to enroll, or who elects not to continue enrollment, in a health benefits plan under this chapter (including a covered individual who elects to receive payments under subsection (d)) may subsequently enroll in a health benefits plan under this chapter based on the status of the covered individual as a covered individual in accordance with such procedures, and after paying such fees, as the Director of the Office of Personnel Management may establish.

   Inserted: "(B) The fact that a covered individual elects not to enroll, or elects not to continue enrollment, in a health benefits plan under this chapter shall not affect the eligibility of the covered individual for benefits under title II of the Social Security Act (42 U.S.C. 401 et seq.).

   Inserted: "(c)(1)(A) A covered individual who elects to enroll in a health benefits plan under this chapter based on the status of the covered individual as a covered individual shall pay a monthly individual premium payment determined in accordance with subparagraph (B).

   Inserted: "(B) The individual premium payment under subparagraph (A) shall be determined based on income, as follows:

   Inserted: "(i) For an individual with an adjusted gross income (as defined under section 62 of the Internal Revenue Code of 1986) of not more than $85,000, the individual premium payment shall be in an amount equal to the employee contribution for the health benefits plan, as determined under section 8906.

   Inserted: "(ii) For an individual with an adjusted gross income of more than $85,000 and not more than $107,000, the individual premium payment shall be in an amount equal to the sum of--

   Inserted: "(I) the employee contribution for the health benefits plan, as determined under section 8906; and

   Inserted: "(II) the product obtained by multiplying--

   Inserted: "(aa) the Government contribution (as determined under section 8906(b)); by

   Inserted: "(bb) 0.05.

   Inserted: "(iii) For an individual with an adjusted gross income of more than $107,000 and not more than $160,000, the individual premium payment shall be in an amount equal to the sum of--

   Inserted: "(I) the employee contribution for the health benefits plan, as determined under section 8906; and

   Inserted: "(II) the product obtained by multiplying--

   Inserted: "(aa) the Government contribution (as determined under section 8906(b)); by

   Inserted: "(bb) 0.1.

   Inserted: "(iv) For an individual with an adjusted gross income of more than $160,000 and not more than $250,000, the individual premium payment shall be in an amount equal to the sum of--

   Inserted: "(I) the employee contribution for the health benefits plan, as determined under section 8906; and

   Inserted: "(II) the product obtained by multiplying--

   Inserted: "(aa) the Government contribution (as determined under section 8906(b)); by

   Inserted: "(bb) 0.15.

   Inserted: "(v) For an individual with an adjusted gross income of more than $250,000 and not more than $1,000,000, the individual premium payment shall be in an amount equal to the sum of--

   Inserted: "(I) the employee contribution for the health benefits plan, as determined under section 8906; and

   Inserted: "(II) the product obtained by multiplying--

   Inserted: "(aa) the Government contribution (as determined under section 8906(b)); by

   Inserted: "(bb) 0.5.

   Inserted: "(vi) For an individual with an adjusted gross income of more than $1,000,000, the individual premium payment shall be in an amount equal to the sum of--

   Inserted: "(I) the employee contribution for the health benefits plan, as determined under section 8906; and

   Inserted: "(II) the Government contribution (as determined under section 8906(b)).

   Inserted: "(C) The Director of the Office of Personnel Management shall adjust the income amounts under subparagraph (B) annually to reflect changes in the Consumer Price Index for all Urban Consumers published by the Department of Labor.

   Inserted: "(2)(A) For a covered individual who is entitled to monthly benefits under section 202 or 223 of the Social Security Act (42 U.S.C. 402 and 423), the monthly premiums of the covered individual under this subchapter shall (except as provided in subparagraph (B) or (C)) be collected by deducting the amount of the premium from the amount of such monthly benefits.

   Inserted: "(B) For a covered individual who is entitled to receive for a month an annuity under the Railroad Retirement Act of 1974 (whether or not the covered individual is also entitled for such month to a monthly insurance benefit under section 202 of the Social Security Act (42 U.S.C. 402)), the monthly premiums of the covered individual under this subchapter shall (except as provided in subparagraph (C)) be collected by deducting the amount thereof from such annuity or pension.

   Inserted: "(C) If a covered individual to whom subparagraph (A) or (B) applies estimates that the amount which will be available for deduction under such subparagraph for any premium payment period will be less than the amount of the monthly premiums for such period, the covered individual may pay to the Director of the Office of Personnel Management such portion of the monthly premiums for such period as the covered individual desires.

   Inserted: "(D) For a covered individual who is not described in subparagraph (A) or (B) and who elects to enroll in a health benefits plan under this chapter, or with respect to whom subparagraph (C) applies, the covered individual shall pay monthly premiums to the Director of the Office of Personnel Management at such times, and in such manner, as the Director shall by regulations prescribe.

   Inserted: "(E) Amounts deducted or paid under this paragraph shall be deposited in the Treasury to the credit of the Employees Health Benefits Fund established under section 8909.

   Inserted: "(F) After consultation with the Director of the Office of Personnel Management, the Secretary of Health and Human Services shall establish procedures for making and depositing deductions under this paragraph.

   Inserted: "(3) The Director of the Office of Personnel Management shall establish procedures for terminating the enrollment of a covered individual in a health benefits plan if the covered individual fails to make timely payment of premiums, which shall allow such a covered individual to reenroll in a health benefits plan under such terms and conditions as the Director may prescribe.

   Inserted: "(d) The Director of the Office of Personnel Management shall make periodic payments to the employer or former employer providing health insurance to a covered individual who makes an election under subsection (b)(1)(B) in a total amount not to exceed the lesser of--

   Inserted: "(1) the cost to the employer or former employer of providing health insurance to the covered individual; and

   Inserted: "(2) the average Government contribution for an individual enrolled in a health benefits plan under this chapter that is available to individuals residing anywhere in the United States.

   Inserted: "(e) For fiscal year 2014 and each fiscal year thereafter, there are appropriated to the Employees Health Benefits Fund established under section 8909, out of any funds in the Treasury not otherwise appropriated--

   Inserted: "(1) an amount equal to--

   Inserted: "(A) the taxes imposed by sections 3101(b) and 3111(b) of the Internal Revenue Code of 1986 with respect to wages reported to the Secretary of the Treasury pursuant to subtitle F of such Code after December 31, 2013, as determined by the Secretary of the Treasury by applying the applicable rates of tax under such sections to such wages, which wages shall be certified by the Commissioner of Social Security on the basis of records of wages established and maintained by the Commissioner of Social Security in accordance with such reports;

   Inserted: "(B) the taxes imposed by section 1401(b) of the Internal Revenue Code of 1986 with respect to self-employment income reported to the Secretary of the Treasury on tax returns under subtitle F of such Code, as determined by the Secretary of the Treasury by applying the applicable rate of tax under such section to such self-employment income, which self-employment income shall be certified by the Commissioner of Social Security on the basis of records of self-employment established and maintained by the Commissioner of Social Security in accordance with such returns; and

   Inserted: "(C) any amounts that, on or after January 1, 2014, are to be deposited in the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act (42 U.S.C. 1395i) under any other provision of law; and

   Inserted: "(2) a Government contribution equal to the difference obtained by subtracting--

   Inserted: "(A) the sum of--

   Inserted: "(i) the total amount of premiums paid by covered individuals under subsection (c)(2) for the fiscal year; and

   Inserted: "(ii) the amount appropriated under paragraph (1); from

   Inserted: "(B) the sum of--

   Inserted: "(i) the total cost for the fiscal year of subscription charges for health benefits plans for covered individuals enrolled in a health benefits plan based on the status of the covered individuals as covered individuals; and

   Inserted: "(ii) the total amount of payments for the fiscal year under subsection (d).

   Inserted: "(f) The Director of the Office of Personnel Management shall establish, in consultation with the Secretary of Health and Human Services acting through the Administrator of the Centers for Medicare & Medicaid Services, procedures to ensure that health benefits plans coordinate with State Medicaid programs with respect to the provision of cost-sharing and other medical assistance for covered individuals enrolled in health benefit plans who are also eligible for medical assistance and enrolled in a State Medicaid program.

   Inserted: "SUBCHAPTER III--HIGH RISK POOL

   Inserted: "Sec. 8941. Reimbursement of costs for high risk individuals

   Inserted: "(a) In this section, the term 'high risk individual' means an individual--

   Inserted: "(1) enrolled in a health benefits plan under this chapter for a contract year; and

   Inserted: "(2) who, of all individuals enrolled in a health benefits plan under this chapter for the contract year, is in the highest 5 percent in terms of benefits paid by a carrier under a health benefits plan relating to the contract year.

   Inserted: "(b) After the end of each contract year beginning on or after January 1, 2014, the Director of the Office of Personnel Management shall--

   Inserted: "(1) identify the high risk individuals for the contract year; and

   Inserted: "(2) pay to a carrier contracting to provide a health benefits plan to a high risk individual for the contract year 90 percent of the benefits paid by the carrier relating to the high risk individual.

   Inserted: "(c)(1) For fiscal year 2014 and each fiscal year thereafter, there are appropriated to the Director of the Office of Personnel Management from the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act (42 U.S.C. 1395i) such sums as are necessary to carry out this section.

   Inserted: "(2) If the amounts appropriated under paragraph (1) are insufficient to carry out this section, for fiscal year 2014 and each fiscal year thereafter, there are appropriated to the Director of the Office of Personnel Management, out of any funds in the Treasury not otherwise appropriated, such sums as are necessary to carry out this section.".

   Inserted: (b) Exemption From Insurance Requirements.--

   Inserted: (1) Amendment to title 5.--Chapter 89 of title 5, United States Code, is amended by inserting after section 8901 the following:

   Inserted: "Sec. 8901A. Exemption from insurance requirements "Title I of the Patient Protection and Affordable Care Act, subtitle A of title X of such Act, and the amendments made by such title I and subtitle A shall not apply to health benefits plans.".

   Inserted: (2) Conforming amendment.--Section 2709 of the Public Health Service Act (42 U.S.C. 300gg 8) (as added by section 10103 of the Patient Protection and Affordable Care Act) is amended--

   Inserted: (A) by striking subsection (g); and

   Inserted: (B) by redesignating subsection (h) as subsection (g).

   Inserted: (c) Technical and Conforming Amendments.--Chapter 89 of title 5, United States Code, is amended--

   Inserted: (1) in the table of sections--

   Inserted: (A) by inserting after the item relating to section 8901 the following:

   Inserted: "8901A. Exemption from insurance requirements.

   Inserted: "subchapter i--federal employees";

   Inserted: and

   Inserted: (B) by adding at the end the following:

   Inserted: "subchapter ii--covered individuals "8921. Health insurance for covered individuals.

   Inserted: "subchapter iii--high risk pool "8941. Reimbursement of costs for high risk individuals.";

   Inserted: (2) in section 8902a(d)(1)--

   Inserted: (A) in subparagraph (A), by adding "or" at the end;

   Inserted: (B) by striking subparagraph (B); and

   Inserted: (C) by redesignating subparagraph (C) as subparagraph (B); and

   Inserted: (3) by striking section 8910(d).

   Inserted: (d) Effective Date; Applicability.--The amendments made by this section shall take effect on the date of enactment of this Act and apply on and after January 1, 2014.

   Original wording

   Strike section 105 and insert the following:

Read automatically from the Congressional Record. Check the original before relying on it.

As printed