State-Based Universal Health Care Act of 2015
This bill amends the Patient Protection and Affordable Care Act to allow states to apply for waivers to health benefits coverage requirements in order to implement a universal health care plan. The state universal health care plan must be at least as comprehensive and affordable as coverage under federal health programs and cover substantially all state residents.
States may apply to waive requirements for:
The Department of Health and Human Services (HHS) must pay a state that assumes responsibility for health coverage currently provided under a federal health program the amount that would otherwise have been spent under the program.
HHS, the Office of Personnel Management, and the Departments of the Treasury, Defense, and Labor must coordinate and consolidate this state waiver process with existing waiver processes to ensure consistency and avoid duplication of effort.
[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3241 Introduced in House (IH)]
114th CONGRESS
1st Session
H. R. 3241
To amend title I of the Patient Protection and Affordable Care Act to
authorize the establishment of, and provide support for, State-based
universal health care systems that provide comprehensive health
benefits to State residents, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 28, 2015
Mr. McDermott introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, Oversight and Government Reform, Armed Services, and
Education and the Workforce, for a period to be subsequently determined
by the Speaker, in each case for consideration of such provisions as
fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title I of the Patient Protection and Affordable Care Act to
authorize the establishment of, and provide support for, State-based
universal health care systems that provide comprehensive health
benefits to State residents, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; PURPOSE.
(a) Short Title.--This Act may be cited as the ``State-Based
Universal Health Care Act of 2015''.
(b) Purpose.--The purpose of this Act is to establish a flexible
framework under which each State can provide comprehensive universal
health coverage to all of its residents.
SEC. 2. WAIVER FOR STATE UNIVERSAL HEALTH CARE.
(a) In General.--Subtitle D of title I of the Patient Protection
and Affordable Care Act (Public Law 111-148) is amended by inserting
after section 1332 (42 U.S.C. 18052) the following new section:
``SEC. 1332A. WAIVER FOR STATE UNIVERSAL HEALTH CARE.
``(a) Application.--
``(1) In general.--A State may apply to the Secretary (as
defined in subsection (g)(3)) for the waiver of so much of the
requirements described in paragraph (2) with respect to health
benefits coverage within that State for plan years beginning on
or after January 1, 2016, as is necessary to implement a
comprehensive State universal health care plan in the State
under this section. Such application shall--
``(A) be filed at such time and in such manner as
the Secretary may require;
``(B) contain such information as the Secretary may
require, including--
``(i) a comprehensive description of the
State legislation and program to implement a
plan meeting the requirements for a waiver
under this section; and
``(ii) a 10-fiscal-year budget plan for
such plan that is budget neutral for the
Federal Government; and
``(C) provide an assurance that the State has
enacted the law described in subsection (b)(2).
``(2) Requirements.--The requirements described in this
paragraph with respect to health benefits coverage within the
State for plan years beginning on or after January 1, 2016, are
as follows:
``(A) Parts I, II, and III of subtitle D.
``(B) Section 1402.
``(C) Sections 36B, 4980H, and 5000A of the
Internal Revenue Code of 1986.
``(D) Title XI of the Social Security Act.
``(E) Title XVIII of the Social Security Act.
``(F) Title XIX of the Social Security Act.
``(G) Title XXI of the Social Security Act.
``(H) Chapter 89 of title 5 of the United States
Code.
``(I) Chapter 55 of title 10, United States Code,
including coverage under the TRICARE program.
``(J) Section 514 of the Employee Retirement Income
Security Act of 1974.
``(3) Pass through of funding.--With respect to a State
waiver under paragraph (1), under which the State assumes
responsibility for health coverage under a specified Federal
health program, including under each of the Federal health care
or subsidy programs specified in subparagraphs (B), (C), (E),
(F), (G), and (H) of paragraph (2), the Secretary shall not
spend Federal health funds that would otherwise have been spent
for such program and shall provide for an alternative means by
which the aggregate amount of such funds shall be paid to the
State for purposes of implementing the State plan under the
waiver. Such amount shall be determined annually by the
Secretary, taking into account the amount that would otherwise
have been spent under such Federal health program with respect
to residents of such State, if such waiver did not apply. Such
amount shall include funds equal to the amount of premium tax
credits, cost-sharing reductions, or small-business credits
under sections 36B and 45R of the Internal Revenue Code of 1986
or under section 1402 that would have been available to
individuals and businesses in the State if such waiver did not
apply.
``(4) Waiver consideration and transparency.--
``(A) In general.--An application for a waiver
under this section shall be considered by the Secretary
in accordance with the regulations described in
subparagraph (B).
``(B) Regulations.--Not later than 180 days after
the date of enactment of the State-Based Universal
Health Care Act of 2015, the Secretary shall promulgate
regulations relating to waivers under this section that
provide--
``(i) a process for public notice and
comment at the State level, including public
hearings, sufficient to ensure a meaningful
level of public input;
``(ii) a process for the submission of an
application that ensures the disclosure of--
``(I) the provisions of law that
the State involved seeks to waive; and
``(II) the specific plans of the
State to ensure that the waiver will be
in compliance with subsection (b);
``(iii) a process for providing public
notice and comment after the application is
received by the Secretary, that is sufficient
to ensure a meaningful level of public input
and that does not impose requirements that are
in addition to, or duplicative of, requirements
imposed under the Administrative Procedure Act,
or requirements that are unreasonable or
unnecessarily burdensome with respect to State
compliance;
``(iv) a process for the submission to the
Secretary of periodic reports by the State
concerning the implementation of the program
under the waiver; and
``(v) a process for the periodic evaluation
by the Secretary with respect to waivers
granted under this section.
``(C) Report.--The Secretary shall annually report
to Congress concerning actions taken by the Secretary
with respect to applications for waivers, and programs
conducted through waivers granted, under this section.
``(b) Granting of Waivers.--
``(1) In general.--The Secretary may grant a request for a
waiver under subsection (a)(1) only if the Secretary determines
that the State plan--
``(A) will provide health benefits coverage to
State residents that is at least as comprehensive as
the health benefits coverage that such residents would
have received under the specified Federal health
program for which such residents would have been
eligible, absent such waiver;
``(B) will provide coverage and cost sharing
protections against excessive out-of-pocket spending to
State residents that are at least as affordable as the
coverage and cost sharing protections under the
specified Federal health program for which such
residents would have been eligible, absent such waiver;
``(C) will provide coverage to substantially all
residents of the State, including substantially all
those otherwise covered under the Federal health care
or subsidy programs specified in subparagraphs (B),
(C), (E), (F), (G), and (H) of subsection (a)(2),
except individuals who are eligible for benefits
through the Indian Health Service or for benefits and
services under title 38, United States Code;
``(D) will be publicly administered by an agency of
the State; and
``(E) will not increase the Federal deficit.
Subparagraph (D) shall not be construed as limiting a State
from contracting with one or more private entities to
administer the plan.
``(2) Requirement to enact a law.--
``(A) In general.--A law described in this
paragraph is a State law that provides for State
actions under a waiver under this section, including
the implementation of the State plan under subsection
(a)(1)(B).
``(B) Termination of opt out.--A State may repeal a
law described in subparagraph (A) and terminate the
authority provided under the waiver with respect to the
State.
``(c) Scope of Waiver.--
``(1) In general.--The Secretary shall determine the scope
of a waiver of a requirement described in subsection (a)(2)
granted to a State under subsection (a)(1).
``(2) Limitation.--Under this section, the Secretary may
not waive any Federal law or requirement that is not listed in
subsection (a)(2).
``(d) Determinations by Secretary.--
``(1) Time for determination.--The Secretary shall make a
determination under subsection (a)(1) not later than 180 days
after the receipt of an application from a State under such
subsection.
``(2) Effect of determination.--
``(A) Granting of waivers.--If the Secretary
determines to grant a waiver under subsection (a)(1),
the Secretary shall notify the State involved of such
determination and the terms and effectiveness of such
waiver.
``(B) Denial of waiver.--If the Secretary
determines a waiver should not be granted under
subsection (a)(1), the Secretary shall notify the State
involved and the appropriate committees of Congress of
such determination and the reasons therefor.
``(e) Term of Waiver.--No waiver under this section may extend over
a period of longer than 5 years unless the State requests continuation
of such waiver, and such request shall be deemed granted unless the
Secretary, within 90 days after the date of its submission to the
Secretary, either denies such request in writing or informs the State
in writing with respect to any additional information which is needed
in order to make a final determination with respect to the request.
``(f) Assuring Coordination.--
``(1) In general.--Not later than 180 days after the
enactment of the State-Based Universal Health Care Act of 2015,
the Secretary of Health and Human Services, the Secretary of
the Treasury, the Director of the Office of Personnel
Management, the Secretary of Defense, and the Secretary of
Labor shall, through the execution of an interagency memorandum
of understanding among such Secretaries and the Director--
``(A) develop a process for coordinating and
consolidating the State waiver processes applicable
under the provisions of this section, and the existing
waiver processes applicable under--
``(i) titles XI, XVIII, XIX, and XXI of the
Social Security Act; and
``(ii) any other Federal law relating to
the provision of health care items or services;
and
``(B) ensure that--
``(i) regulations (including regulations
required under subsection (a)(4)(B)), rulings,
and interpretations issued by such Secretaries
and the Director relating to the same matter
over which two or more such Secretaries or
Director have responsibility under this section
are administered so as to have the same effect
at all times; and
``(ii) coordination of policies relating to
the granting, implementation, and continuation
of waivers through such Secretaries and
Director in order to have a coordinated
strategy that avoids duplication of effort by
the States or Secretaries and Director and
ensures clarity about waiver application status
and approval.
``(2) Single application.--The process under paragraph
(1)(A) shall permit a State to submit a single application for
a waiver under all of the provisions of this section and the
provisions of law listed under clauses (i) and (ii) of such
paragraph.
``(3) Submission of conforming amendments.--The Secretary
of Health and Human Services, in coordination with the other
Secretaries (including the Director of the Office of Personnel
Management), shall submit to Congress such recommendations for
such technical and conforming amendments to law as may be
appropriate to assist in the implementation of this section.
``(g) Definitions.--In this section:
``(1) Health benefits coverage.--The term `health benefits
coverage'--
``(A) means--
``(i) health insurance coverage, as such
term is defined in section 2791(b) of the
Public Health Service Act (42 U.S.C. 300gg-
91(b)); and
``(ii) coverage under a group health plan,
as such term is defined in section 2791(a) of
the Public Health Service Act (42 U.S.C. 300gg-
91(a)); and
``(B) includes any medical coverage or health
benefits provided under any specified Federal health
program described in subparagraphs (A) through (E) of
paragraph (4).
``(2) Resident.--With respect to a State, the term
`resident' means an individual who is a citizen or national of
the United States or an alien lawfully residing in the State,
and whose primary residence (as defined by the State) is
located in the State.
``(3) Secretary.--The term `Secretary' means--
``(A) the Secretary of Health and Human Services
with respect to waivers relating to the provisions
described in subparagraphs (A), (B), and (D) through
(G) of paragraph (2) of subsection (a);
``(B) the Secretary of the Treasury with respect to
waivers relating to the provisions described in
subparagraph (C) of such paragraph;
``(C) the Director of the Office of Personnel
Management with respect to waivers relating to the
provisions described in subparagraph (H) of such
paragraph;
``(D) the Secretary of Defense with respect to
waivers relating to the provisions described in
subparagraph (I) of such paragraph; and
``(E) the Secretary of Labor with respect to
waivers relating to the provisions described in
subparagraph (J) of such paragraph.
``(4) Specified federal health program.--The term
`specified Federal health program' means all of the following
programs:
``(A) The Medicare program under title XVIII of the
Social Security Act.
``(B) The Medicaid program under title XIX of the
Social Security Act.
``(C) The Children's Health Insurance Program under
title XXI of the Social Security Act.
``(D) The Federal Employees Health Benefits Plan
under chapter 89 of title 5 of the United States Code.
``(E) Medical coverage under chapter 55 of title
10, United States Code, including coverage under the
TRICARE program.
``(F) An Exchange established under this subtitle.
``(G) Subsidies under section 1402.
``(H) Tax credits under sections 36B and 45R of the
Internal Revenue Code of 1986.''.
(b) Clerical Amendment.--The table of contents in section 1(b) of
such Act is amended by inserting after the item relating to section
1332 the following new item:
``Sec. 1332A. Waiver for State universal health care.''.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E1147)
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Armed Services, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Armed Services, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Armed Services, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Armed Services, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Armed Services, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Armed Services, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Military Personnel.
Referred to the Subcommittee on Health, Employment, Labor, and Pensions.