Since everyone is so hooked on one small part of this, let’s try to look at the full thing and see what it would have done. Before anyone comments, read this whole diary because it has entire sections from the bill. Let’s discuss that instead of one paragraph.
LINK
It will provide universal coverage, benefits emphasizing primary and preventive care, and free choice of providers. Inpatient services, long term care, a broad range of services for mental illness and substance abuse, and care coordination services will also be covered.
A seven-member national board (the Board) appointed by the President will establish a national health budget specifying the total federal and state expenditures to be made for covered health care services. The Board will work together with similar boards in each of the fifty states and the District of Columbia to administer the Program.
(snip)
The Program amends the tax code to create the American Health Security Trust Fund and appropriates to the Fund specified tax revenues, current health program receipts, and tax credits and subsidies under the Affordable Care Act. While the final structure of the financing component is still under consideration and is subject to change, the tax revenues in the draft include a new health care income tax, an employer payroll tax, a surcharge on high income individuals, and a tax on securities transactions.
Here is the offending paragraph everyone is up in arms about.
The federal government would collect and distribute all funds to the states for the operation of the state programs to pay for the covered services. Budget increases would be limited to the rate of growth of the gross domestic product. Each state’s budget for administrative expenses would be capped at three percent.
Now here’s the next part people seem to overlook, that the FED would administer if state does not, NO OPTING OUT.
Each state would have the choice to administer its own program or have the federal Board administer it. The state program could negotiate with providers and consult with its advisory boards to allocate funds. The state program could also contract with private companies to provide administrative functions, as Medicare currently does through its administrative regions. State programs could negotiate with providers to pay outpatient facilities and individual practitioners on a capitated, salaried, or other prospective basis or on a fee-for service basis according to a rate schedule. Rates would be designed to incentivize primary and preventive care while maintaining a global budget, bringing provider, patients, and all stakeholders to the table to best determine value and reimbursement.
Finally, the Program also relieves businesses from the heavy administrative burdens of providing health care coverage, puts all businesses on an even playing field in terms of healthcare coverage, and increases the competitiveness of American companies in the global marketplace. Every other industrialized nation has been able to use the power of a public authority to provide universal health care. The American Health Security Act of 2013 seeks to do just that for all Americans and their businesses.
FROM THE BILL ITSELF:
SEC. 103. ENROLLMENT.
(a) In General.—Each State health security program shall provide a mechanism for the enrollment of individuals entitled or eligible for benefits under this Act. The mechanism shall—
(1) include a process for the automatic enrollment of individuals at the time of birth in the United States and at the time of legal immigration into the United States or other acquisition of resident status in the United States;
(2) provide for the enrollment, as of January 1, 2015, of all individuals who are eligible to be enrolled as of such date; and
(3) include a process for the enrollment of individuals made eligible for health care services under subsections (b) and (c) of section 102.
(b) Availability Of Applications.—Each State health security program shall make applications for enrollment under the program available—
(1) at employment and payroll offices of employers located in the State;
(2) at local offices of the Social Security Administration;
(3) at social services locations;
(4) at out-reach sites (such as provider and practitioner locations, especially community health centers); and
(5) at other locations (including post offices and schools) accessible to a broad cross-section of individuals eligible to enroll.
(c) Issuance Of Health Security Cards.—In conjunction with an individual’s enrollment for benefits under this Act, the State health security program shall provide for the issuance of a health security card (to be referred to as a “smart card”) that shall be used for purposes of identification and processing of claims for benefits under the program. The State health security program may provide for issuance of such cards by employers for purposes of carrying out enrollment pursuant to subsection (a)(2).
And Look, once you’re in you’re in! No matter if you move to another state. So no matter where you are, you’re covered. I think we can all get behind that.
SEC. 104. PORTABILITY OF BENEFITS.
(a) In General.—To ensure continuous access to benefits for health care services covered under this Act, each State health security program—
(1) shall not impose any minimum period of residence in the State before residents of the State are entitled to, or eligible for, such benefits under the program;
(2) shall provide continuation of payment for covered health care services to individuals who have terminated their residence in the State and established their residence in another State, for the duration of any waiting period imposed in the State of new residency for establishing entitlement to, or eligibility for, such services; and
(3) shall provide for the payment for health care services covered under this Act provided to individuals while temporarily absent from the State based on the following principles:
(A) Payment for such health care services is at the rate that is approved by the State health security program in the State in which the services are provided, unless the States concerned agree to apportion the cost between them in a different manner.
(B) Payment for such health care services provided outside the United States is made on the basis of the amount that would have been paid by the State health security program for similar services rendered in the State, with due regard, in the case of hospital services, to the size of the hospital, standards of service, and other relevant factors.
(b) Cross-Border Arrangements.—A State health security program for a State may negotiate with such a program in an adjacent State a reciprocal arrangement for the coverage under such other program of health care services to enrollees residing in the border region.
And here’s EVERYTHING IT WOULD COVER.
SEC. 201. COMPREHENSIVE BENEFITS.
(a) In General.—Subject to the succeeding provisions of this title, individuals enrolled for benefits under this Act are entitled to have payment made under a State health security program for the following items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:
(1) HOSPITAL SERVICES.—Inpatient and outpatient hospital care, including 24-hour-a-day emergency services.
(2) PROFESSIONAL SERVICES.—Professional services of health care practitioners authorized to provide health care services under State law, including patient education and training in self-management techniques.
(3) COMMUNITY-BASED PRIMARY HEALTH SERVICES.—Community-based primary health services (as defined in section 202(a)).
(4) PREVENTIVE SERVICES.—Preventive services (as defined in section 202(b)).
(5) LONG-TERM, ACUTE, AND CHRONIC CARE SERVICES.—
(A) Nursing facility services.
(B) Home health services.
(C) Home and community-based long-term care services (as defined in section 202(c)) for individuals described in section 203(a).
(D) Hospice care.
(E) Services in intermediate care facilities for individuals with an intellectual disability.
(6) PRESCRIPTION DRUGS, BIOLOGICALS, INSULIN, MEDICAL FOODS.—
(A) Outpatient prescription drugs and biologics, as specified by the Board consistent with section 615.
(B) Insulin.
(C) Medical foods (as defined in section 202(e)).
(7) DENTAL SERVICES.—Dental services (as defined in section 202(h)).
(8) MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT SERVICES.—Mental health and substance abuse treatment services (as defined in section 202(f)).
(9) DIAGNOSTIC TESTS.—Diagnostic tests.
(10) OTHER ITEMS AND SERVICES.—
(A) OUTPATIENT THERAPY.—Outpatient physical therapy services, outpatient speech pathology services, and outpatient occupational therapy services in all settings.
(B) DURABLE MEDICAL EQUIPMENT.—Durable medical equipment.
(C) HOME DIALYSIS.—Home dialysis supplies and equipment.
(D) AMBULANCE.—Emergency ambulance service.
(E) PROSTHETIC DEVICES.—Prosthetic devices, including replacements of such devices.
(F) ADDITIONAL ITEMS AND SERVICES.—Such other medical or health care items or services as the Board may specify.
(b) Prohibition Of Balance Billing.—As provided in section 531, no person may impose a charge for covered services for which benefits are provided under this Act.
(c) No Duplicate Health Insurance.—Each State health security program shall prohibit the sale of health insurance in the State if payment under the insurance duplicates payment for any items or services for which payment may be made under such a program.
(d) State Program May Provide Additional Benefits.—Nothing in this Act shall be construed as limiting the benefits that may be made available under a State health security program to residents of the State at the expense of the State.
(e) Employers May Provide Additional Benefits.—Nothing in this Act shall be construed as limiting the additional benefits that an employer may provide to employees or their dependents, or to former employees or their dependents.
(f) Taft-Hartley And MEW Benefit Plans.—Notwithstanding any other provision of law, a health plan may be provided for under a collective bargaining agreement or a MEWA if such plan is limited to coverage that is supplemental to the coverage provided for under the State-based American Health Security Program and available only to employees or their dependents or to retirees or their dependents.
SEC. 202. DEFINITIONS RELATING TO SERVICES.
(a) Community-Based Primary Health Services.—In this title, the term “community-based primary health services” means ambulatory health services furnished—
(1) by a rural health clinic;
(2) by a federally qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act), and which, for purposes of this Act, include services furnished by State and local health agencies;
(3) in a school-based setting;
(4) by public educational agencies and other providers of services to children entitled to assistance under the Individuals with Disabilities Education Act for services furnished pursuant to a written Individualized Family Services Plan or Individual Education Plan under such Act; and
(5) public and private nonprofit entities receiving Federal assistance under the Public Health Service Act.
(b) Preventive Services.—
(1) IN GENERAL.—In this title, the term “preventive services” means items and services—
(A) which—
(i) are specified in paragraph (2); or
(ii) the Board determines to be effective in the maintenance and promotion of health or minimizing the effect of illness, disease, or medical condition; and
(B) which are provided consistent with the periodicity schedule established under paragraph (3).
(2) SPECIFIED PREVENTIVE SERVICES.—The services specified in this paragraph are as follows:
(A) Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
(B) Prenatal and well-baby care (for infants under 1 year of age).
(C) Well-child care (including periodic physical examinations, hearing and vision screening, and developmental screening and examinations) for individuals under 18 years of age, including evidence-informed preventive care and screenings included in the comprehensive guidelines of the Health Resources and Services Administration.
(D) Periodic screening mammography, Pap smears, and colorectal examinations and examinations for prostate cancer.
(E) Physical examinations.
(F) Family planning services.
(G) Routine eye examinations, eyeglasses, and contact lenses.
(H) Hearing aids, but only upon a determination of a certified audiologist or physician that a hearing problem exists and is caused by a condition that can be corrected by use of a hearing aid.
(I) Evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force.
(J) With respect to women, such additional preventive care and screenings not described in subparagraph (I) that are included in the comprehensive guidelines of the Health Resources and Services Administration.
(3) SCHEDULE.—The Board shall establish, in consultation with experts in preventive medicine and public health and taking into consideration those preventive services recommended by the Preventive Services Task Force and published as the Guide to Clinical Preventive Services, a periodicity schedule for the coverage of preventive services under paragraph (1). Such schedule shall take into consideration the cost-effectiveness of appropriate preventive care and shall be revised not less frequently than once every 5 years, in consultation with experts in preventive medicine and public health.
(c) Home And Community-Based Long-Term Care Services.—In this title, the term “home and community-based long-term care services” means the following services provided to an individual to enable the individual to remain in such individual’s place of residence within the community:
(1) Home health aide services.
(2) Adult day health care, social day care or psychiatric day care.
(3) Medical social work services.
(4) Care coordination services, as defined in subsection (g)(1).
(5) Respite care, including training for informal caregivers.
(6) Personal assistance services, and homemaker services (including meals) incidental to the provision of personal assistance services.
(d) Home Health Services.—
(1) IN GENERAL.—The term “home health services” means items and services described in section 1861(m) of the Social Security Act and includes home infusion services.
(2) HOME INFUSION SERVICES.—The term “home infusion services” includes the nursing, pharmacy, and related services that are necessary to conduct the home infusion of a drug regimen safely and effectively under a plan established and periodically reviewed by a physician and that are provided in compliance with quality assurance requirements established by the Secretary.
(e) Medical Foods.—In this title, the term “medical foods” means foods which are formulated to be consumed or administered enterally under the supervision of a physician and which are intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.
(f) Mental Health And Substance Abuse Treatment Services.—
(1) SERVICES DESCRIBED.—In this title, the term “mental health and substance abuse treatment services” means the following services related to the prevention, diagnosis, treatment, and rehabilitation of mental illness and promotion of mental health:
(A) INPATIENT HOSPITAL SERVICES.—Inpatient hospital services furnished primarily for the diagnosis or treatment of mental illness or substance abuse if (with respect to services furnished to an individual described in section 204(b)(1)) such services are furnished in conformity with the plan of an organized system of care for mental health and substance abuse services in accordance with section 204(b)(2).
(B) INTENSIVE RESIDENTIAL SERVICES.—Intensive residential services (as defined in paragraph (2)).
(C) OUTPATIENT SERVICES.—Outpatient treatment services of mental illness or substance abuse (other than intensive community-based services under subparagraph (D)) for an unlimited number of days during any calendar year furnished in accordance with standards established by the Secretary for the management of such services, and, in the case of services furnished to an individual described in section 204(b)(1) who is not an inpatient of a hospital, in conformity with the plan of an organized system of care for mental health and substance abuse services in accordance with section 204(b)(2).
(D) INTENSIVE COMMUNITY-BASED SERVICES.—Intensive community-based services (as described in paragraph (3)).
(2) INTENSIVE RESIDENTIAL SERVICES DEFINED.—
(A) IN GENERAL.—Subject to subparagraphs (B) and (C), the term “intensive residential services” means inpatient services provided in any of the following facilities:
(i) Residential detoxification centers.
(ii) Crisis residential programs or mental illness residential treatment programs.
(iii) Therapeutic family or group treatment homes.
(iv) Residential centers for substance abuse treatment.
(B) REQUIREMENTS FOR FACILITIES.—No service may be treated as an intensive residential service under subparagraph (A) unless the facility at which the service is provided—
(i) is legally authorized to provide such service under the law of the State (or under a State regulatory mechanism provided by State law) in which the facility is located or is certified to provide such service by an appropriate accreditation entity approved by the State in consultation with the Secretary; and
(ii) meets such other requirements as the Secretary may impose to ensure the quality of the intensive residential services provided.
(C) SERVICES FURNISHED TO AT-RISK CHILDREN.—In the case of services furnished to an individual described in section 204(b)(1), no service may be treated as an intensive residential service under this subsection unless the service is furnished in conformity with the plan of an organized system of care for mental health and substance abuse services in accordance with section 204(b)(2).
(D) MANAGEMENT STANDARDS.—No service may be treated as an intensive residential service under subparagraph (A) unless the service is furnished in accordance with standards established by the Secretary for the management of such services.
(3) INTENSIVE COMMUNITY-BASED SERVICES DEFINED.—
(A) IN GENERAL.—The term “intensive community-based services” means the items and services described in subparagraph (B) prescribed by a physician (or, in the case of services furnished to an individual described in section 204(b)(1), by an organized system of care for mental health and substance abuse services in accordance with such section) and provided under a program described in subparagraph (D) under the supervision of a physician (or, to the extent permitted under the law of the State in which the services are furnished, a non-physician mental health professional) pursuant to an individualized, written plan of treatment established and periodically reviewed by a physician (in consultation with appropriate staff participating in such program) which sets forth the physician’s diagnosis, the type, amount, frequency, and duration of the items and services provided under the plan, and the goals for treatment under the plan, but does not include any item or service that is not furnished in accordance with standards established by the Secretary for the management of such services.
(B) ITEMS AND SERVICES DESCRIBED.—The items and services described in this subparagraph are—
(i) partial hospitalization services consisting of the items and services described in subparagraph (C);
(ii) psychiatric rehabilitation services;
(iii) day treatment services for individuals under 19 years of age;
(iv) in-home services;
(v) case management services, including collateral services designated as such case management services by the Secretary;
(vi) ambulatory detoxification services; and
(vii) such other items and services as the Secretary may provide (but in no event to include meals and transportation),
that are reasonable and necessary for the diagnosis or active treatment of the individual’s condition, reasonably expected to improve or maintain the individual’s condition and functional level and to prevent relapse or hospitalization, and furnished pursuant to such guidelines relating to frequency and duration of services as the Secretary shall by regulation establish (taking into account accepted norms of medical practice and the reasonable expectation of patient improvement).
(C) ITEMS AND SERVICES INCLUDED AS PARTIAL HOSPITALIZATION SERVICES.—For purposes of subparagraph (B)(i), partial hospitalization services consist of the following:
(i) Individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under State law).
(ii) Occupational therapy requiring the skills of a qualified occupational therapist.
(iii) Services of social workers, trained psychiatric nurses, behavioral aides, and other staff trained to work with psychiatric patients (to the extent authorized under State law).
(iv) Drugs and biologicals furnished for therapeutic purposes (which cannot, as determined in accordance with regulations, be self-administered).
(v) Individualized activity therapies that are not primarily recreational or diversionary.
(vi) Family counseling (the primary purpose of which is treatment of the individual’s condition).
(vii) Patient training and education (to the extent that training and educational activities are closely and clearly related to the individual’s care and treatment).
(viii) Diagnostic services.
(D) PROGRAMS DESCRIBED.—A program described in this subparagraph is a program (whether facility-based or freestanding) which is furnished by an entity—
(i) legally authorized to furnish such a program under State law (or the State regulatory mechanism provided by State law) or certified to furnish such a program by an appropriate accreditation entity approved by the State in consultation with the Secretary; and
(ii) meeting such other requirements as the Secretary may impose to ensure the quality of the intensive community-based services provided.
(g) Care Coordination Services.—
(1) IN GENERAL.—In this title, the term “care coordination services” means services provided by care coordinators (as defined in paragraph (2)) to individuals described in paragraph (3) for the coordination and monitoring of home and community-based long-term care services and services offered through medical homes to ensure appropriate, cost-effective utilization of such services in a comprehensive and continuous manner, and includes—
(A) transition management between inpatient facilities and community-based services, including assisting patients in identifying and gaining access to appropriate ancillary services; and
(B) evaluating and recommending appropriate treatment services, in cooperation with patients and other providers and in conjunction with any quality review program or plan of care under section 205.
(2) CARE COORDINATOR.—
(A) IN GENERAL.—In this title, the term “care coordinator” means an individual or nonprofit or public agency or organization which the State health security program determines—
(i) is capable of performing directly, efficiently, and effectively the duties of a care coordinator described in paragraph (1); and
(ii) demonstrates capability in establishing and periodically reviewing and revising plans of care, and in arranging for and monitoring the provision and quality of services under any plan.
(B) INDEPENDENCE.—State health security programs shall establish safeguards to ensure that care coordinators have no financial interest in treatment decisions or placements. Care coordination may not be provided through any structure or mechanism through which quality review is performed.
(3) ELIGIBLE INDIVIDUALS.—An individual described in this paragraph is an individual described in section 203 (relating to individuals qualifying for long-term and chronic care services).
(h) Dental Services.—
(1) IN GENERAL.—In this title, subject to subsection (b), the term “dental services” means the following:
(A) Emergency dental treatment, including extractions, for bleeding, pain, acute infections, and injuries to the maxillofacial region.
(B) Prevention and diagnosis of dental disease, including examinations of the hard and soft tissues of the oral cavity and related structures, radiographs, dental sealants, fluorides, and dental prophylaxis.
(C) Treatment of dental disease, including non-cast fillings, periodontal maintenance services, and endodontic services.
(D) Space maintenance procedures to prevent orthodontic complications.
(E) Orthodontic treatment to prevent severe malocclusions.
(F) Full dentures.
(G) Medically necessary oral health care.
(H) Any items and services for special needs patients that are not described in subparagraphs (A) through (G) and that—
(i) are required to provide such patients the items and services described in subparagraphs (A) through (G);
(ii) are required to establish oral function (including general anesthesia for individuals with physical or emotional limitations that prevent the provision of dental care without such anesthesia);
(iii) consist of orthodontic care for severe dentofacial abnormalities; or
(iv) consist of prosthetic dental devices for genetic or birth defects or fitting for such devices.
(I) Any dental care for individuals with a seizure disorder that is not described in subparagraphs (A) through (H) and that is required because of an illness, injury, disorder, or other health condition that results from such seizure disorder.
(2) LIMITATIONS.—Dental services are subject to the following limitations:
(A) PREVENTION AND DIAGNOSIS.—
(i) EXAMINATIONS AND PROPHYLAXIS.—The examinations and prophylaxis described in paragraph (1)(B) are covered only consistent with a periodicity schedule established by the Board, which schedule may provide for special treatment of individuals less than 18 years of age and of special needs patients.
(ii) DENTAL SEALANTS.—The dental sealants described in such paragraph are not covered for individuals 18 years of age or older. Such sealants are covered for individuals less than 10 years of age for protection of the 1st permanent molars. Such sealants are covered for individuals 10 years of age or older for protection of the 2d permanent molars.
(B) TREATMENT OF DENTAL DISEASE.—Prior to January 1, 2020, the items and services described in paragraph (1)(C) are covered only for individuals less than 18 years of age and special needs patients. On or after such date, such items and services are covered for all individuals enrolled for benefits under this Act, except that endodontic services are not covered for individuals 18 years of age or older.
(C) SPACE MAINTENANCE.—The items and services described in paragraph (1)(D) are covered only for individuals at least 3 years of age, but less than 13 years of age and—
(i) are limited to posterior teeth;
(ii) involve maintenance of a space or spaces for permanent posterior teeth that would otherwise be prevented from normal eruption if the space were not maintained; and
(iii) do not include a space maintainer that is placed within 6 months of the expected eruption of the permanent posterior tooth concerned.
(3) DEFINITIONS.—For purposes of this title:
(A) MEDICALLY NECESSARY ORAL HEALTH CARE.—The term “medically necessary oral health care” means oral health care that is required as a direct result of, or would have a direct impact on, an underlying medical condition. Such term includes oral health care directed toward control or elimination of pain, infection, or reestablishment of oral function.
(B) SPECIAL NEEDS PATIENT.—The term “special needs patient” includes an individual with a genetic or birth defect, a developmental disability, or an acquired medical disability.
(i) Nursing Facility; Nursing Facility Services.—Except as may be provided by the Board, the terms “nursing facility” and “nursing facility services” have the meanings given such terms in sections 1919(a) and 1905(f), respectively, of the Social Security Act.
(j) Services In Intermediate Care Facilities For Individuals With An Intellectual Disability.—Except as may be provided by the Board—
(1) the term “intermediate care facility for individuals with an intellectual disability” has the meaning given the term “intermediate care facility for individuals with mental retardation” in section 1905(d) of the Social Security Act (as in effect before the enactment of this Act); and
(2) the term “services in intermediate care facilities for individuals with an intellectual disability” means services described in section 1905(a)(15) of such Act (as so in effect) in an intermediate care facility for individuals with an intellectual disability to an individual determined to require such services in accordance with standards specified by the Board and comparable to the standards described in section 1902(a)(31)(A) of such Act (as so in effect).
(k) Other Terms.—Except as may be provided by the Board, the definitions contained in section 1861 of the Social Security Act shall apply.
And here is EXACTLY how he would pay for it.
SEC. 800. AMENDMENT OF 1986 CODE; SECTION 15 NOT TO APPLY.
(a) Amendment Of 1986 Code.—Except as otherwise expressly provided, whenever in this title an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of the Internal Revenue Code of 1986.
(b) Section 15 Not To Apply.—The amendments made by subtitle B shall not be treated as a change in a rate of tax for purposes of section 15 of the Internal Revenue Code of 1986.
SEC. 801. AMERICAN HEALTH SECURITY TRUST FUND.
(a) In General.—There is hereby created on the books of the Treasury of the United States a trust fund to be known as the American Health Security Trust Fund (in this section referred to as the “Trust Fund”). The Trust Fund shall consist of such gifts and bequests as may be made and such amounts as may be deposited in, or appropriated to, such Trust Fund as provided in this Act.
(b) Appropriations Into Trust Fund.—
(1) TAXES.—There are hereby appropriated to the Trust Fund for each fiscal year (beginning with fiscal year 2015), out of any moneys in the Treasury not otherwise appropriated, amounts equivalent to 100 percent of the aggregate increase in tax liabilities under the Internal Revenue Code of 1986 which is attributable to the application of the amendments made by this title. The amounts appropriated by the preceding sentence shall be transferred from time to time (but not less frequently than monthly) from the general fund in the Treasury to the Trust Fund, such amounts to be determined on the basis of estimates by the Secretary of the Treasury of the taxes paid to or deposited into the Treasury; and proper adjustments shall be made in amounts subsequently transferred to the extent prior estimates were in excess of or were less than the amounts that should have been so transferred.
(2) CURRENT PROGRAM RECEIPTS.—Notwithstanding any other provision of law, there are hereby appropriated to the Trust Fund for each fiscal year (beginning with fiscal year 2015) the amounts that would otherwise have been appropriated to carry out the following programs:
(A) The Medicare program, under parts A, B, and D of title XVIII of the Social Security Act (other than amounts attributable to any premiums under such parts).
(B) The Medicaid program, under State plans approved under title XIX of such Act.
(C) The Federal employees health benefit program, under chapter 89 of title 5, United States Code.
(D) The TRICARE program (formerly known as the CHAMPUS program), under chapter 55 of title 10, United States Code.
(E) The maternal and child health program (under title V of the Social Security Act), vocational rehabilitation programs, programs for drug abuse and mental health services under the Public Health Service Act, programs providing general hospital or medical assistance, and any other Federal program identified by the Board, in consultation with the Secretary of the Treasury, to the extent the programs provide for payment for health services the payment of which may be made under this Act.
(c) Incorporation Of Provisions.—The provisions of subsections (b) through (i) of section 1817 of the Social Security Act shall apply to the Trust Fund under this Act in the same manner as they applied to the Federal Hospital Insurance Trust Fund under part A of title XVIII of such Act, except that the American Health Security Standards Board shall constitute the Board of Trustees of the Trust Fund.
(d) Transfer Of Funds.—Any amounts remaining in the Federal Hospital Insurance Trust Fund or the Federal Supplementary Medical Insurance Trust Fund after the settlement of claims for payments under title XVIII have been completed, shall be transferred into the American Health Security Trust Fund.
SEC. 811. PAYROLL TAX ON EMPLOYERS.
(a) In General.—Section 3111 (relating to tax on employers) is amended by redesignating subsections (c), (d), and (e) as subsections (d), (e), and (f), respectively, and by inserting after subsection (b) the following new subsection:
“(c) Health Care.—In addition to other taxes, there is hereby imposed on every employer an excise tax, with respect to having individuals in his employ, equal to 6.7 percent of the wages (as defined in section 3121(a)) paid by him with respect to employment (as defined in section 3121(b)).”.
(b) Self-Employment Income.—Section 1401 (relating to rate of tax on self-employment income) is amended by redesignating subsection (c) as subsection (d) and inserting after subsection (b) the following new subsection:
“(c) Health Care.—In addition to other taxes, there shall be imposed for each taxable year, on the self-employment income of every individual, a tax equal to 6.7 percent of the amount of the self-employment income for such taxable year.”.
(c) Comparable Taxes For Railroad Services.—
(1) TAX ON EMPLOYERS.—Section 3221 is amended by redesignating subsections (c) and (d) as subsections (d) and (e), respectively, and by inserting after subsection (b) the following new subsection:
“(c) Health Care.—In addition to other taxes, there is hereby imposed on every employer an excise tax, with respect to having individuals in his employ, equal to 6.7 percent of the compensation paid by such employer for services rendered to such employer.”.
(2) TAX ON EMPLOYEE REPRESENTATIVES.—Section 3211 (relating to tax on employee representatives) is amended by redesignating subsection (c) as subsection (d) and inserting after subsection (b) the following new paragraph:
“(c) Health Care.—In addition to other taxes, there is hereby imposed on the income of each employee representative a tax equal to 6.7 percent of the compensation received during the calendar year by such employee representative for services rendered by such employee representative.”.
(3) NO APPLICABLE BASE.—Subparagraph (A) of section 3231(e)(2) is amended by adding at the end thereof the following new clause:
“(iv) HEALTH CARE TAXES.—Clause (i) shall not apply to the taxes imposed by sections 3221(c) and 3211(c).”.
(4) TECHNICAL AMENDMENTS.—
(A) Subsection (d) of section 3211, as redesignated by paragraph (2), is amended by striking “and (b)” and inserting “, (b), and (c)”.
(B) Subsection (d) of section 3221, as redesignated by paragraph (1), is amended by striking “and (b)” and inserting “, (b), and (c)”.
(d) Conforming Amendments.—
(1) Paragraph (5) of section 51(c) is amended—
(A) by striking “3111(d)(3)” and inserting “3111(e)(3)”, and
(B) by striking “3111(d)” both places it appears and inserting “3111(e)”.
(2) Paragraph (2) of section 52(c) is amended by striking “3111(e)” and inserting “3111(f)”.
(3) Paragraph (5) of section 3121(z) is amended by striking “3111(c)” and inserting “3111(d)”.
(4) The fifth sentence of subsection (a) of section 6051 is amended by striking “3111(c)” and inserting “3111(d)”.
(e) Effective Date.—The amendments made by this section shall apply to remuneration paid after December 31, 2014.
SEC. 812. HEALTH CARE INCOME TAX.
(a) General Rule.—Subchapter A of chapter 1 (relating to determination of tax liability) is amended by adding at the end thereof the following new part:
“PART VIII—HEALTH CARE RELATED TAXES
“Subpart A—Health Care Income Tax On Individuals
“Sec. 59B. Health care income tax.
“SEC. 59B. HEALTH CARE INCOME TAX.
“(a) Imposition Of Tax.—In the case of an individual, there is hereby imposed a tax (in addition to any other tax imposed by this subtitle) equal to the applicable amount with respect to the taxpayer for the taxable year.
“(b) Applicable Amount.—For purposes of this section—
“(1) IN GENERAL.—In the case of a taxpayer not described in paragraph (2), the applicable amount with respect to any taxable year shall be determined in accordance with the following table:
“If taxable income is: |
The applicable amount is: |
Not over $200,000 |
2.2% of taxable income |
Over $200,000 but not over $400,000 |
$4,400, plus 3.2% of the excess over $200,000 |
Over $400,000 but not over $600,000 |
$10,800, plus 4.2% of the excess over $400,000 |
Over $600,000 |
$19,200, plus 5.2% of the excess over $600,000. |
“(2) JOINT RETURNS AND SURVIVING SPOUSES.—In the case of a joint return or a surviving spouse (as defined in section 2(a)), the applicable amount with respect to any taxable year shall be determined in accordance with the following table:
“If taxable income is: |
The applicable amount is: |
Not over $250,000 |
2.2% of taxable income |
Over $250,000 but not over $400,000 |
$5,500, plus 3.2% of the excess over $250,000 |
Over $400,000 but not over $600,000 |
$10,300, plus 4.2% of the excess over $400,000 |
Over $600,000 |
$18,700, plus 5.2% of the excess over $600,000. |
“(3) INFLATION ADJUSTMENT.—
“(A) IN GENERAL.—In the case of any taxable year beginning after 2015, each of the dollar amounts in the tables contained in paragraphs (1) and (2) shall be increased by an amount equal to—
“(i) such dollar amount, multiplied by
“(ii) 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 2014’ for ‘calendar year 1992’ in subparagraph (B) thereof.
“(B) ROUNDING.—If any amount after adjustment under subparagraph (A) is not a multiple of $1,000, such amount shall be rounded to the next lowest multiple of $1,000.
“(c) No Credits Against Tax; No Effect On Minimum Tax.—The tax imposed by this section shall not be treated as a tax imposed by this chapter for purposes of determining—
“(1) the amount of any credit allowable under this chapter, or
“(2) the amount of the minimum tax imposed by section 55.
“(d) Special Rules.—
“(1) TAX TO BE WITHHELD, ETC.—For purposes of this title, the tax imposed by this section shall be treated as imposed by section 1.
“(2) REIMBURSEMENT OF TAX BY EMPLOYER NOT INCLUDIBLE IN GROSS INCOME.—The gross income of an employee shall not include any payment by his employer to reimburse the employee for the tax paid by the employee under this section.
“(3) OTHER RULES.—The rules of section 59A(d) shall apply to the tax imposed by this section.”.
(b) Clerical Amendment.—The table of parts for subchapter A of chapter 1 is amended by adding at the end the following new item:
“PART VIII—HEALTH CARE RELATED TAXES”.
(c) Effective Date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2014.
SEC. 813. SURCHARGE ON HIGH INCOME INDIVIDUALS.
(a) In General.—Part VIII of subchapter A of chapter 1, as added by this title, is amended by adding at the end the following new subpart:
“Sec. 59C. Surcharge on high income individuals.
“SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS.
“(a) General Rule.—In the case of a taxpayer other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.
“(b) Taxpayers Not Making A Joint Return.—In the case of any taxpayer other than a taxpayer making a joint return under section 6013 or a surviving spouse (as defined in section 2(a)), subsection (a) shall be applied by substituting ‘$500,000’ for ‘$1,000,000’.
“(c) Modified Adjusted Gross Income.—For purposes of this section, the term ‘modified adjusted gross income’ means adjusted gross income reduced by any deduction (not taken into account in determining adjusted gross income) allowed for investment interest (as defined in section 163(d)). In the case of an estate or trust, adjusted gross income shall be determined as provided in section 67(e).
“(d) Special Rules.—
“(1) NONRESIDENT ALIEN.—In the case of a nonresident alien individual, only amounts taken into account in connection with the tax imposed under section 871(b) shall be taken into account under this section.
“(2) CITIZENS AND RESIDENTS LIVING ABROAD.—The dollar amount in effect under subsection (a) (after the application of subsection (b)) shall be decreased by the excess of—
“(A) the amounts excluded from the taxpayer’s gross income under section 911, over
“(B) the amounts of any deductions or exclusions disallowed under section 911(d)(6) with respect to the amounts described in subparagraph (A).
“(3) CHARITABLE TRUSTS.—Subsection (a) shall not apply to a trust all the unexpired interests in which are devoted to one or more of the purposes described in section 170(c)(2)(B).
“(4) NOT TREATED AS TAX IMPOSED BY THIS CHAPTER FOR CERTAIN PURPOSES.—The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.”.
(b) Clerical Amendment.—The table of subparts for part VIII of subchapter A of chapter 1, as added by this title, is amended by inserting after the item relating to subpart A the following new item:
“SUBPART B—SURCHARGE ON HIGH INCOME INDIVIDUALS”.
(c) Section 15 Not To Apply.—The amendment made by subsection (a) shall not be treated as a change in a rate of tax for purposes of section 15 of the Internal Revenue Code of 1986.
(d) Effective Date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2014.
SEC. 821. TAX ON SECURITIES TRANSACTIONS.
(a) In General.—Chapter 36 is amended by inserting after subchapter B the following new subchapter:
“Sec. 4475. Tax on securities transactions.
“SEC. 4475. TAX ON SECURITIES TRANSACTIONS.
“(a) Imposition Of Tax.—There is hereby imposed a tax on each covered transaction with respect to any security.
“(b) Rate Of Tax.—
“(1) IN GENERAL.—Except as otherwise provided in this subsection, the rate of such tax shall be equal to 0.02 percent of the fair market value of the security.
“(2) SWAPS.—In the case of a security described in subsection (d)(1)(D), the rate of such tax shall be equal to 0.02 percent of the fair market value of the underlying property with respect to, or the notional principal amount of, the derivative financial instrument involved in such transaction.
“(3) SHORT-TERM DEBT INSTRUMENTS.—In the case of a covered transaction with respect to a security described in subsection (d)(1)(C) which has a fixed maturity date not more than 1 year from the date of issue, the rate of such tax shall be equal to 0.02 percent of the fair market value of such security.
“(c) Covered Transaction.—For purposes of this section, the term ‘covered transaction’ means—
“(1) except as provided in paragraph (2), any purchase if—
“(A) such purchase occurs on a trading facility located in the United States, or
“(B) the purchaser or seller is a United States person, or
“(2) any transaction with respect to a security described in subsection (d)(1)(D), if any party with rights under such security is a United States person or if such transaction is facilitated by a United States person, including a trading facility located in the United States or a broker.
“(d) Security And Other Definitions.—For purposes of this section—
“(1) IN GENERAL.—The term ‘security’ means—
“(A) any share of stock in a corporation,
“(B) any partnership or beneficial ownership interest in a widely held or publicly traded partnership or trust,
“(C) any note, bond, debenture, or other evidence of indebtedness issued by a nongovernmental entity the beneficial ownership of which is traded on an established market, or
“(D) any evidence of an interest in, or a derivative financial instrument in—
“(i) any security described in subparagraph (A), (B), or (C),
“(ii) any specified index, or
“(iii) any other note, bond, or debenture issued by a nongovernmental entity.
“(2) DERIVATIVE FINANCIAL INSTRUMENT.—The term ‘derivative financial instrument’ means any option, forward contract, short position, notional principal contract, credit default swap, or any similar financial instrument.
“(3) SPECIFIED INDEX.—The term ‘specified index’ means any 1 or more of any combination of—
“(A) a fixed rate, price, or amount, or
“(B) a variable rate, price, or amount,
which is based on any current objectively determinable information which is not within the control of any of the parties to the contract or instrument and is not unique to any of the parties’ circumstances.
“(e) Exceptions To Imposition Of Tax.—
“(1) EXCEPTION FOR INITIAL ISSUES.—No tax shall be imposed under subsection (a) on any covered transaction with respect to the initial issuance of any security described in subparagraph (A), (B), or (C) of subsection (d)(1).
“(2) EXCEPTION FOR RETIREMENT ACCOUNTS, ETC.—No tax shall be imposed under subsection (a) on any covered transaction with respect to any security which is held in any plan, account, or arrangement described in section 220, 223, 401(a), 403(a), 403(b), 408, 408A, 529, or 530 (including assets held in a segregated asset account described in section 817 as part of any such plan, account, or arrangement).
“(3) EXCEPTION FOR CERTAIN MUTUAL FUND TRANSACTIONS.—No tax shall be imposed under subsection (a) on any covered transaction—
“(A) with respect to the purchase of any interest in a regulated investment company (as defined in section 851) which issues only stock which is redeemable on the demand of the stock holder,
“(B) by a regulated investment company (as so defined) which is 100 percent owned by 1 or more plans, accounts, or arrangements described in paragraph (2), and
“(C) to the extent such tax is properly allocable to any class of shares of a regulated investment company (as so defined) which is 100 percent owned by 1 or more plans, accounts, or arrangements described in paragraph (2).
“(f) By Whom Paid.—
“(1) IN GENERAL.—The tax imposed by this section shall be paid by—
“(A) in the case of a transaction which occurs on a trading facility located in the United States, such trading facility,
“(B) in the case of a transaction not described in subparagraph (A) which is executed by a broker, such broker,
“(C) in the case of a transaction not described in subparagraph (A) or (B), with respect to a security described in section (d)(1)(D), the party identified by the Secretary, or
“(D) in any other case, the purchaser with respect to the transaction.
“(2) WITHHOLDING IF PURCHASER IS NOT A UNITED STATES PERSON.—See section 1447 for withholding by seller if purchaser is a foreign person.
“(g) Administration.—The Secretary shall carry out this section in consultation with the Securities and Exchange Commission and the Commodity Futures Trading Commission.
“(h) Guidance; Regulations.—The Secretary shall—
“(1) provide guidance regarding such information reporting concerning covered transactions as the Secretary deems appropriate, and
“(2) prescribe such regulations as are necessary or appropriate to prevent avoidance of the purposes of this section, including the use of non-United States persons in such transactions or the improper allocation of taxes to classes of shares described in subsection (e)(3)(C).”.
(b) Credit For First $100,000 Of Stock Transactions Per Year.—Subpart C of part IV of subchapter A of chapter 1 is amended by inserting after section 36B the following new section:
“SEC. 36C. CREDIT FOR SECURITIES TRANSACTION TAXES.
“(a) Allowance Of Credit.—In the case of any purchaser with respect to a covered transaction, there shall be allowed as a credit against the tax imposed by this subtitle for the taxable year an amount equal to the lesser of—
“(1) the aggregate amount of tax imposed under section 4475 on covered transactions during the taxable year with respect to which the taxpayer is the purchaser, or
“(2) $250 ($500 in the case of a joint return).
“(b) Aggregation Rule.—For purposes of this section, all persons treated as a single employer under subsection (a) or (b) of section 52, or subsection (m) or (o) of section 414, shall be treated as one taxpayer.
“(c) Definitions.—For purposes of this section, any term used in this section which is also used in section 4475 shall have the same meaning as when used in section 4475.”.
(c) Withholding.—Subchapter A of chapter 3 is amended by adding at the end the following new section:
“SEC. 1447. WITHHOLDING ON SECURITIES TRANSACTIONS.
“(a) In General.—In the case of any outbound securities transaction, the transferor shall deduct and withhold a tax equal to the tax imposed under section 4475 with respect to such transaction.
“(b) Outbound Securities Transaction.—For purposes of this section, the term ‘outbound securities transaction’ means any covered transaction to which section 4475(a) applies if—
“(1) such transaction does not occur on a trading facility located in the United States, and
“(2) the purchaser with respect to such transaction is not a United States person.”.
(d) Conforming Amendments.—
(1) Section 6211(b)(4)(A), as amended by the Patient Protection and Affordable Care Act, is amended by inserting “36C,” after “36B,”.
(2) Section 1324(b)(2) of title 31, United States Code, is amended by inserting “36C,” after “36B,”.
(3) The table of subchapters for chapter 36 is amended by inserting after the item relating to subchapter B the following new item:
“Subchapter C. Tax on securities transactions.”.
(4) The table of sections for subchapter A of chapter 3 is amended by adding at the end the following new item:
“Sec. 1447. Withholding on securities transactions.”.
(5) The table of sections for subpart C of part IV of subchapter A of chapter 1 is amended by inserting after the item relating to section 36B the following new item:
“Sec. 36C. Credit for securities transaction taxes.”.
(e) Effective Date.—The amendments made by this section shall apply to transactions occurring more than 180 days after the date of the enactment of this Act.
So what was that about him not having a detailed plan? If Clinton is referring to this as “his plan” I think it’s a pretty damn good one, don’t you?