SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the `Empowering Patients First Act'.

(b) Table of Contents- The table of contents for this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I--TAX INCENTIVES FOR MAINTAINING HEALTH INSURANCE COVERAGE

Sec. 101. Refundable tax credit for health insurance costs of low-income individuals.

Sec. 102. Advance payment of credit as premium payment for qualified health insurance.

Sec. 103. Election of tax credit instead of alternative government or group plan benefits.

Sec. 104. Deduction for qualified health insurance costs of individuals.

Sec. 105. Limitation on abortion funding.

Sec. 106. Non-discrimination on abortion and respect for rights of conscience.

Sec. 107. Equal employer contribution rule to promote choice.

Sec. 108. Limitations on State restrictions on employer auto-enrollment.

Sec. 109. Credit for small employers adopting auto-enrollment and defined contribution options.

Sec. 110. Require employers to disclose amounts paid for employer-provided health plan coverage.

Sec. 111. HSA modifications and clarifications.

TITLE II--HEALTH INSURANCE POOLING MECHANISMS FOR INDIVIDUALS

Subtitle A--Safety Net for Individuals With Pre-Existing Conditions

Sec. 201. Requiring operation of high-risk pool or other mechanism as condition for availability of tax credit.

Subtitle B--Federal Block Grants for State Insurance Expenditures

Sec. 211. Federal block grants for State insurance expenditures.

Subtitle C--Health Care Access and Availability

Sec. 221. Expansion of access and choice through individual membership associations (IMAs).

Subtitle D--Small Business Health Fairness

Sec. 231. Short title.

Sec. 232. Rules governing association health plans.

Sec. 233. Clarification of treatment of single employer arrangements.

Sec. 234. Enforcement provisions relating to association health plans.

Sec. 235. Cooperation between Federal and State authorities.

Sec. 236. Effective date and transitional and other rules.

TITLE III--INTERSTATE MARKET FOR HEALTH INSURANCE

Sec. 301. Cooperative governing of individual health insurance coverage.

TITLE IV--SAFETY NET REFORMS

Sec. 401. Requiring outreach and coverage before expansion of eligibility.

Sec. 402. Easing administrative barriers to State cooperation with employer-sponsored insurance coverage.

Sec. 403. Improving beneficiary choice in SCHIP.

Sec. 404. Liability protections for health center volunteer practitioners.

Sec. 405. Liability protections for health center practitioners providing services in emergency areas.

TITLE V--MEDICAL LIABILITY AND UNCOMPENSATED CARE REFORMS

Sec. 501. Short title.

Sec. 502. Findings and purpose.

Sec. 503. Encouraging speedy resolution of claims.

Sec. 504. Compensating patient injury.

Sec. 505. Maximizing patient recovery.

Sec. 506. Additional health benefits.

Sec. 507. Punitive damages.

Sec. 508. Authorization of payment of future damages to claimants in health care lawsuits.

Sec. 509. Definitions.

Sec. 510. Effect on other laws.

Sec. 511. State flexibility and protection of States' rights.

Sec. 512. Applicability; effective date.

Sec. 513. Sense of Congress.

Sec. 514. State grants to create administrative health care tribunals.

Sec. 515. Affirmative defense based on compliance with best practice guidelines.

Sec. 516. Bad debt deduction for doctors to partially offset the cost of providing uncompensated care required to be provided under amendments made by the Emergency Medical Treatment and Labor Act.

TITLE VI--WELLNESS AND PREVENTION

Sec. 601. Providing financial incentives for treatment compliance.

TITLE VII--TRANSPARENCY AND INSURANCE REFORM MEASURES

Sec. 701. Receipt and response to requests for claim information.

TITLE VIII--QUALITY

Sec. 801. Prohibition on certain uses of data obtained from comparative effectiveness research; accounting for personalized medicine and differences in patient treatment response.

Sec. 802. Establishment of performance-based quality measures.

TITLE IX--STATE TRANSPARENCY PLAN PORTAL

Sec. 901. Providing information on health coverage options and health care providers.

TITLE X--PHYSICIAN PAYMENT REFORM

Sec. 1001. Sustainable growth rate reform.

TITLE XI--INCENTIVES TO REDUCE PHYSICIAN SHORTAGES

Subtitle A--Federally Supported Student Loan Funds for Medical Students

Sec. 1101. Federally Supported Student Loan Funds for Medical Students.

Subtitle B--Loan Forgiveness for Primary Care Providers

Sec. 1111. Loan forgiveness for primary care providers.

TITLE XII--OFFSETS

Subtitle A--Enforcing Discretionary Spending Limits

Sec. 1201. Enforcing discretionary spending limits.

Subtitle B--Repeal of Unused Stimulus Funds

Sec. 1211. Rescission and repeal in ARRA.

Subtitle C--Savings From Health Care Efficiencies

Sec. 1221. Medicare DSH report and payment adjustments in response to coverage expansion.

Sec. 1222. Reduction in Medicaid DSH.

Subtitle D--Fraud, Waste, and Abuse

Sec. 1231. Provide adequate funding to HHS OIG and HCFAC.

Sec. 1232. Improved enforcement of the Medicare secondary payor provisions.

Sec. 1233. Strengthen Medicare provider enrollment standards and safeguards.

Sec. 1234. Tracking banned providers across State lines.

Sec. 1235. Reinstate the Medicare trigger.

TITLE I--TAX INCENTIVES FOR MAINTAINING HEALTH INSURANCE COVERAGE

SEC. 101. REFUNDABLE TAX CREDIT FOR HEALTH INSURANCE COSTS OF LOW-INCOME INDIVIDUALS.

(a) In General- Subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to refundable credits) is amended by inserting after section 36A the following new section:

`SEC. 36B. HEALTH INSURANCE COSTS OF LOW-INCOME INDIVIDUALS.

`(a) In General- In the case of an individual, there shall be allowed as a credit against the tax imposed by subtitle A the aggregate amount paid by the taxpayer for coverage of the taxpayer and the taxpayer's qualifying family members under qualified health insurance for eligible coverage months beginning in the taxable year.

`(b) Limitations-

`(1) IN GENERAL- The amount allowable as a credit under subsection (a) for the taxable year shall not exceed the lesser of--

`(A) the sum of the monthly limitations for months during such taxable year that the taxpayer or the taxpayer's qualifying family members is an eligible individual, and

`(B) the aggregate premiums paid by the taxpayer for the taxable year for coverage described in subsection (a).

`(2) MONTHLY LIMITATION- The monthly limitation for any month is the credit percentage of 1/12 of the sum of--

`(A) $2,000 for coverage of the taxpayer ($4,000 in the case of a joint return for coverage of the taxpayer and the taxpayer's spouse), and

`(B) $500 for coverage of each dependent of the taxpayer.

`(3) CREDIT PERCENTAGE-

`(A) IN GENERAL- For purposes of this section, the term `credit percentage' means 100 percent reduced by 1 percentage point for each $1,000 (or fraction thereof) by which the taxpayer's adjusted gross income for the taxable year exceeds the threshold amount.

`(B) THRESHOLD AMOUNT- For purposes of this paragraph, the term `threshold amount' means, with respect to any taxpayer for any taxable year, 200 percent of the Federal poverty guideline (as determined by the Secretary of Health and Human Service for the taxable year) applicable to the taxpayer.

`(4) ONLY 2 DEPENDENTS TAKEN INTO ACCOUNT- Not more than 2 dependents of the taxpayer may be taken into account under paragraphs (2)(C) and (3)(B).

`(5) INFLATION ADJUSTMENT- In the case of any taxable year beginning in a calendar year after 2009, each dollar amount contained in paragraph (2) shall be increased by an amount equal to--

`(A) such dollar amount, multiplied by

`(B) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year in which the taxable year begins, determined by substituting `calendar year 2008' for `calendar year 1992' in subparagraph (B) thereof.

Any increase determined under the preceding sentence shall be rounded to the nearest multiple of $50.

`(c) Eligible Coverage Month- For purposes of this section, the term `eligible coverage month' means, with respect to any individual, any month if, as of the first day of such month, the individual--

`(1) is covered by qualified health insurance,

`(2) does not have other specified coverage, and

`(3) is not imprisoned under Federal, State, or local authority.

`(d) Qualifying Family Member- For purposes of this section, the term `qualifying family member' means--

`(1) in the case of a joint return, the taxpayer's spouse, and

`(2) any dependent of the taxpayer.

`(e) Qualified Health Insurance- For purposes of this section, the term `qualified health insurance' means health insurance coverage (other than excepted benefits as defined in section 9832(c)) which constitutes medical care.

`(f) Other Specified Coverage- For purposes of this section, an individual has other specified coverage for any month if, as of the first day of such month--

`(1) COVERAGE UNDER MEDICARE, MEDICAID, OR SCHIP- Such individual--

`(A) is entitled to benefits under part A of title XVIII of the Social Security Act or is enrolled under part B of such title, or

`(B) is enrolled in the program under title XIX or XXI of such Act (other than under section 1928 of such Act).

`(2) CERTAIN OTHER COVERAGE- Such individual--

`(A) is enrolled in a health benefits plan under chapter 89 of title 5, United States Code,

`(B) is entitled to receive benefits under chapter 55 of title 10, United States Code,

`(C) in entitled to receive benefits under chapter 17 of title 38, United States Code, or

`(D) is enrolled in a group health plan (within the meaning of section 5000(b)(1)) which is subsidized by the employer.

`(g) Special Rules-

`(1) COORDINATION WITH ADVANCE PAYMENTS OF CREDIT; RECAPTURE OF EXCESS ADVANCE PAYMENTS- With respect to any taxable year--

`(A) the amount which would (but for this subsection) be allowed as a credit to the taxpayer under subsection (a) shall be reduced (but not below zero) by the aggregate amount paid on behalf of such taxpayer under section 7529 for months beginning in such taxable year, and

`(B) the tax imposed by section 1 for such taxable year shall be increased by the excess (if any) of--

`(i) the aggregate amount paid on behalf of such taxpayer under section 7529 for months beginning in such taxable year, over

`(ii) the amount which would (but for this subsection) be allowed as a credit to the taxpayer under subsection (a).

`(2) COORDINATION WITH OTHER DEDUCTIONS- Amounts taken into account under subsection (a) shall not be taken into account in determining--

`(A) any deduction allowed under section 162(l), 213, or 224, or

`(B) any credit allowed under section 35.

`(3) MEDICAL AND HEALTH SAVINGS ACCOUNTS- Amounts distributed from an Archer MSA (as defined in section 220(d)) or from a health savings account (as defined in section 223(d)) shall not be taken into account under subsection (a).

`(4) DENIAL OF CREDIT TO DEPENDENTS AND NONPERMANENT RESIDENT ALIEN INDIVIDUALS- No credit shall be allowed under this section to any individual who is--

`(A) not a citizen or lawful permanent resident of the United States for the calendar year in which the taxable year begins, or

`(B) a dependent with respect to another taxpayer for a taxable year beginning in the calendar year in which such individual's taxable year begins.

`(5) INSURANCE WHICH COVERS OTHER INDIVIDUALS- For purposes of this section, rules similar to the rules of section 213(d)(6) shall apply with respect to any contract for qualified health insurance under which amounts are payable for coverage of an individual other than the taxpayer and qualifying family members.

`(6) TREATMENT OF PAYMENTS- For purposes of this section--

`(A) PAYMENTS BY SECRETARY- Payments made by the Secretary on behalf of any individual under section 7529 (relating to advance payment of credit for health insurance costs of low-income individuals) shall be treated as having been made by the taxpayer on the first day of the month for which such payment was made.

`(B) PAYMENTS BY TAXPAYER- Payments made by the taxpayer for eligible coverage months shall be treated as having been made by the taxpayer on the first day of the month for which such payment was made.

`(7) REGULATIONS- The Secretary may prescribe such regulations and other guidance as may be necessary or appropriate to carry out this section, section 6050W, and section 7529.'.

(b) Conforming Amendments-

(1) Paragraph (2) of section 1324(b) of title 31, United States Code, is amended by inserting `36B,' after `36A,'.

(2) The table of sections for subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by inserting after the item relating to section 36A the following new item:

`Sec. 36B. Health insurance costs of low-income individuals.'.

(c) Effective Date- The amendments made by this section shall apply to taxable years beginning after December 31, 2009.

(d) Sense of Congress- It is the sense of Congress that the cost of the advanceable refundable credit under sections 36B and 7529 of the Internal Revenue Code of 1986, as added by this title, will be offset by savings derived from the provisions of title XII.

SEC. 102. ADVANCE PAYMENT OF CREDIT AS PREMIUM PAYMENT FOR QUALIFIED HEALTH INSURANCE.

(a) In General- Chapter 77 of the Internal Revenue Code of 1986 (relating to miscellaneous provisions) is amended by adding at the end the following:

`SEC. 7529. ADVANCE PAYMENT OF CREDIT AS PREMIUM PAYMENT FOR QUALIFIED HEALTH INSURANCE.

`(a) General Rule- Not later than January 1, 2010, the Secretary shall establish a program for making payments to providers of qualified health insurance (as defined in section 36B(e)) on behalf of taxpayers eligible for the credit under section 36B. Except as otherwise provided by the Secretary, such payments shall be made on the basis of the adjusted gross income of the taxpayer for the preceding taxable year.

`(b) Certification Process and Proof of Coverage- For purposes of this section, payments may be made pursuant to subsection (a) only with respect to individuals for whom a qualified health insurance costs credit eligibility certificate is in effect.'.

(b) Disclosure of Return Information for Purposes of Advance Payment of Credit as Premiums for Qualified Health Insurance-

(1) IN GENERAL- Subsection of section 6103 of such Code is amended by adding at the end the following new paragraph:

`(21) DISCLOSURE OF RETURN INFORMATION FOR PURPOSES OF ADVANCE PAYMENT OF CREDIT AS PREMIUMS FOR QUALIFIED HEALTH INSURANCE- The Secretary may, on behalf of taxpayers eligible for the credit under section 36B, disclose to a provider of qualified health insurance (as defined in section 36(e)), and persons acting on behalf of such provider, return information with respect to any such taxpayer only to the extent necessary (as prescribed by regulations issued by the Secretary) to carry out the program established by section 7529 (relating to advance payment of credit as premium payment for qualified health insurance).'.

(2) CONFIDENTIALITY OF INFORMATION- Paragraph (3) of section 6103(a) of such Code is amended by striking `or (20)' and inserting `(20), or (21)'.

(3) UNAUTHORIZED DISCLOSURE- Paragraph (2) of section 7213(a) of such Code is amended by striking `or (20)' and inserting `(20), or (21)'.

(c) Information Reporting-

(1) IN GENERAL- Subpart B of part III of subchapter A of chapter 61 of such Code (relating to information concerning transactions with other persons) is amended by adding at the end the following new section:

While the two health care reform plans that are serving as the main building blocks for the merged bill have been publicly available for quite some time, I would note that the Republican leadership’s health care plan remains a secret, unless perhaps it does not exist.

Needless to say, I fully understand if your plan is still under development, and would not presume to suggest that you publicly share draft legislative text for even an individual element of your plan, let alone an entire bill, before it is finalized.

However, as soon as a comprehensive Republican alternative is complete, I hope you will be willing to immediately make it public. I am sure you agree that the American people deserve the opportunity to fully review both parties’ health careform plans before we begin this important debate.

Harry Reid may not be the only one full of crap. Excerpted from his letter of yesterday:



Can you point to where he says what you claim he said? I missed the link in your post.

- However, as soon as a comprehensive Republican alternative is complete, I hope you will be willing to immediately make it public.

- However, as soon as a comprehensive Republican alternative is complete, I hope you will be willing to immediately make it public.

You just supported my whole point. The rhetoric you listed here, from Reid, is giving a negative assertion of actual activity....that means he is making statements that lead the listener to believe that a certain thing has not been done.

seekingtruth said:

Please.....isnt that ALL you and the right ever do?
lets have a moment of clarity for a second.
That Reid is plagerizing the rebulican handbook, or cramping your style, ill at least give you that.
[Edited 11/3/09 8:25am]

I think Harrr Reid made a mistake when he said that Republians has done no legislation in regards to Healthcare Reform.

The truth is all the health care reform done in the last 8 years by the Bush Administration HAS NOT BROUGHT done cost or INSURED MORE PEOPLE.

In any private sector if you implemet anything and it has been a failure they will not be allowed to come up with more plans. That is how the Republicans needs to be treated.

I am always slow to accuse people in authority of "lying" however it has to be said in this case.

Harry Reid is claiming the republicans have produced no legislation in regards to Healthcare Reform. This is not true, and he knows it. It is a matter of public record that bills have been introduced....below are those bills.

Patients Choice Act

House - http://thomas.loc.gov/cgi...11IOEi4e::
Senate - http://thomas.loc.gov/cgi...11IOEi4e::


Health Care Freedom Act

House - http://thomas.loc.gov/cgi...117er1R9::
Senate - http://thomas.loc.gov/cgi...117er1R9::


Empowering Patients First Act

http://thomas.loc.gov/cgi...bPm2v8:e0:

So, you can say you don't agree with the policies in these bill, but you cannot say they have not been recommended. I personally like some of the stuff in them and some of the stuff is, soso.

Either way, at least these bills are Constitutionally viable....which Pelosi's is not and Reids is....oh wait Reid has not introduced a bill yet; so he is full of crap on two levels.

seekingtruth said:

When Republicans are waving reams of blank papers around during the Presidential Address where the President was called a liar by a member of congress, you really think it's farfetched to believe Republicans haven't contributed any crafted bills in response to the healthcare crisis? I agree with you Harry Reid is full of it, but I haven't heard any Republican lawmaker articulate any other vision than NO.

violetblues said:

And Republicans do it....IT PISSES ME OFF!!
It's dishonest, and it doesn't matter which party it is; it's wrong.

Please....isn't that ALL you on the left ever do?
When you don't have a good argument, you bring out the, "Well, you did it too.."

SupaFunkyOrgangrinderSexy said:

Then READ the FREAKING bills above.

That pretty clearly articulates a different vision. You are judging this by what the media outlets are willing to tell you (ie CNN, MSNBC, Letterman, Leno didn't say anything about these bills, so the republicans must not be articulating it.)

Luckily, I had a conservative news organization talk about the bills being proposed, so I could understand the world in it's ACTUAL state.

seekingtruth said:

In the other message boards I frequent, that defense is generally invoked by Republicans.

seekingtruth said:

Are there hardcopies of these "bills" or did someone off the cuff articulate a bulletpoint outline to pass off as action?

SupaFunkyOrgangrinderSexy said:

I'm not surprised that you haven't even looked into the links above. Those are the full bills with their official filing numbers, and they are on a governemnt site.....

The bills were presented months ago and totally ignored by the dems. And yes, the same dems who promised a "New Washington".....

seekingtruth said:

I went into those links and couldn't read anything because I got THIS MESSAGE:

Please resubmit your search
Search results are only retained for a limited amount of time.Your search results have either been deleted, or the file has been updated with new information.

So, like the phantom bills you're touting, your links are full of phantom information too!


Democrats should ignore anything the Party of No has to offer. They're only offering the same failed policies that brought us to the point that Democrats need to clean up.

,
[Edited 11/3/09 12:08pm]

seekingtruth said:

I went into those links and couldn't read anything because I got THIS MESSAGE:

Please resubmit your search
Search results are only retained for a limited amount of time.Your search results have either been deleted, or the file has been updated with new information.

So, like the phantom bills you're touting, your links are full of phantom information too!


Democrats should ignore anything the Party of No has to offer. They're only offering the same failed policies that brought us to the point that Democrats need to clean up.

,
[Edited 11/3/09 12:08pm]

Katana750 said:

The Bush administration did not implement any major Healtcare reforms other than the Prescription Bill....

Your argument here is not valid as it is trying to use Bush's policies as a standard these new measures that are being brought forward now.

The big issue is cost. The democrats are on board the "Coverage" bandwagon because it earns votes, but if you increase coverage without reducing cost, you have done nothing for the real problem...(and then you're only talking about providing coverage for an additional 9% of the population; the cost does not even close to justify)

The point of all the above bills is to reduce cost...

seekingtruth said:

Did you ever wonder why the previous administration did nothing other than Prescription Bill when it comes to Healthcare Reform? Don't you agree that the health care cost went up and that more people went uninsured because of the lack of actions by the previous administration?

So why does the Democrats have to listen to the party that did only a Prescription Bill and that absolutely did nothing to bring down Cost? When the plan that you implemented did not do anything to cut down cost or insure more people don’t you think it is fair for people not to take their concerns seriously? Why are Republicans so worried about cost when they added trillions to deficit and they have nothing to show for.

seekingtruth said:

Did you ever wonder why the previous administration did nothing other than Prescription Bill when it comes to Healthcare Reform? Don't you agree that the health care cost went up and that more people went uninsured because of the lack of actions by the previous administration?

So why does the Democrats have to listen to the party that did only a Prescription Bill and that absolutely did nothing to bring down Cost? When the plan that you implemented did not do anything to cut down cost or insure more people don’t you think it is fair for people not to take their concerns seriously? Why are Republicans so worried about cost when they added trillions to deficit and they have nothing to show for.

Katana750 said:

Oh, and one more thing....OF COURSE I question the fact that Bush did nothing about healthcare costs.

Why do liberals think that conservatives drink Bush's bath water? I supported some of his policies and resented others....

Katana750 said:

Costs have been rising for some time. Neither party has done anything.

The point is, the dems have a bill out that does nothing more than expand the powers of government, and the republicans have a bill out that looks to reduce cost.

You are a little bit too caught up on your bitterness towards the Bush Administration...that has nothing to do with what plans are on the table right now.

Katana750 said:

Oh, and one more thing....OF COURSE I question the fact that Bush did nothing about healthcare costs.

Why do liberals think that conservatives drink Bush's bath water? I supported some of his policies and resented others....

seekingtruth said:

Because we have been in this forum since the inception and conservatives never decried anything their beloved president did while in office and criticized Obama from DAY ONE. We have seen conservatives disappear completely in this forum after their party lost power in 2006 and it's only now that any of you call for any accountability on the Iraq and Afghanistan war. your party and it's members are so discredited that you really shouldn't even be showing your face in public.....

Because we have been in this forum since the inception and conservatives never decried anything their beloved president did while in office and criticized Obama from DAY ONE.

We have seen conservatives disappear completely in this forum after their party lost power in 2006 and it's only now that any of you call for any accountability on the Iraq and Afghanistan war.

your party and it's members are so discredited that you really shouldn't even be showing your face in public.....

I hope they savage you and your kind. You deserve nothing less.

SupaFunkyOrgangrinderSexy said:

The last time I was discovered as pointless arguments...I was just as frustrated.....so fear not, I understand.

seekingtruth said:

Pointless arguments Puh LEASE! I hope you reap what you have sewn.

SupaFunkyOrgangrinderSexy said:

So, what's your point?

The problem is, there's at least a chance that I am going to reap what you have sewn....

seekingtruth said:

I hope you reap whatever 1 - You deserve and 2 - You think is going to hurt you politically and socially. I wish this with all my being.