Title I – Tax Incentives for Maintaining Health Insurance Coverage

Section 101 creates a refundable income tax credit of a maximum of the lesser of either the aggregate amount of money paid in premiums in a single taxable year or the sum of the monthly limitations for months that the taxpayer or the taxpayer's qualifying members are considered eligible. The monthly limitation is one-twelfth of the sum of $2,000 ($4,000 if filing a joint tax return) and $500 per dependent. A maximum of two dependents can be claimed and the credit adjusts to inflation annually. The tax credit can only be claimed if the taxpayer and the taxpayer's spouse and dependents have purchased a qualified health insurance plan. The credit can be claimed in full by taxpayers at or below 200% of the federal poverty level (FPL). Above 200% of the FPL, the percentage of the credit that can be claimed decreases by 1 percentage point for each $1,000 earned over 200% of the FPL. Section 102 directs the Secretary of Health and Human Services (HHS) to create a payment system to allow for the credit to be paid directly to the insurance provider to cover premium expenses in advance. Under Section 103, individuals who are otherwise eligible for Medicare, Medicaid, a state child health insurance program (SCHIP), TRICARE, veterans' benefits, federal employee health benefits (FEHBP), or a group health plan subsidized by the employer may choose to claim the aforementioned tax credit instead of receiving any benefits under such program.

Section 104 creates an itemized tax deduction for individuals equal to the amount paid in premiums by the taxpayer for qualified health insurance in a taxable year, provided that the deduction does not exceed the average value of the national health exclusion for employer-sponsored health insurance.

Section 105 prohibits funds authorized from the Act, as well as tax credits and deductions in the Internal Revenue Code (IRC), from being used to pay for any abortion or to pay for any part of the costs of health insurance plans that cover abortion procedures, excluding instances in which the pregnancy was the result of rape or incest, or if the life of the mother is endangered. Section 106 further prohibits the federal government from discriminating against any health care professional, health care facility, health care organization, or health insurance plan that does not provide, pay for, provide coverage of, or refer for abortions. This prohibition extends to state and local governments that receive federal financial assistance.

Section 107 lifts the 25% excise tax on nonconforming group health plans, plans that don't meet all coverage requirements, and exempts these plans from the Health Insurance Portability and Accountability Act (HIPAA), if any employee can choose to have the employer or employee organization pay a contribution of a minimum of the contribution amount to any health insurance provider for coverage instead of receiving coverage under the group health plan, and if any coverage provided to a participant or beneficiary is treated as a group health plan under section 9801 of the IRC, which permits group health plans to exclude individuals with preexisting conditions under certain circumstances. This extends to the FEHBP, in which contributions to all plans are to be equal irrespective of which benefits plan an employee is enrolled in.

Section 108 prohibits states from establishing laws that would prevent any employers that are allowed an exclusion of gross income, a deduction, or a tax credit for the federal income tax for health benefits from automatically enrolling employees in a group health plan, on the condition that employees are to be enrolled in the plan with the lowest premiums, and that employees are given the option to opt out of auto-enrollment for the employer-sponsored plan. Employers are to provide their employees with a 30-day period to elect to opt out, after which employees will be automatically enrolled.

Section 109 creates a new small business health care tax credit to replace the one currently present in the PPACA. The number of employees in a "small business", for the purpose of this tax credit, would be increased from 25 to 50. The maximum tax credit allowed is revised to be equal to $1,500 more than the sum paid in premiums for an auto-enrolled plan by the taxpayer in all previous taxable years. The tax credit is to be a part of the general business credit.

Section 110 makes a number of modifications to several health tax deductions. Capitated payments to physicians and pre-paid physician fees are to be considered medical expenses under the medical expense tax deduction. Individuals eligible for treatment in the Veteran and Indian health systems will not be considered covered under a health plan merely because they receive periodic medical care from the foregoing health care systems, and will thus not be considered eligible for the health savings account (HSA) tax deduction for that reason.

Title II – Health Insurance Pooling Mechanisms for Individuals

Title III – Interstate Market for Health Insurance

Section 301 allows for the creation of interstate cooperatives between state governments, including the District of Columbia (D.C.), to sell individual health insurance. In these cooperatives, insurers can choose which state serves as the "primary" state, the state whose laws regulate the insurance provider. Coverage laws of "secondary" states, states that are not the primary state, do not apply to the insurer, excluding if the secondary state requires the insurer to pay nondiscriminatory state taxes, to register with the state Insurance Commissioner for legal purposes, to submit financial reports of the insurer's financial condition, to comply with court injunctions, to participate in any state insurance insolvency guarantee association, and to comply with state laws regarding fraud, abuse, and unfair claim settlement practices. Insurers are required to disclose to individuals in secondary states information regarding the insurer's primary and secondary states and are required to submit to primary and secondary state Insurance Commissioners a copy of the plan, including quarterly financial reports certified by an independent public accountant, and an opinion on loss and loss adjustment expense reserves made by a member of the AAA or a qualified loss reserve specialist. Insurers cannot provide individual health insurance in secondary states if the Insurance Commissioner of those states do not use a risk-based capital formula for determining capital and surplus requirements for insurers.

Similar to the PPACA, insurers in these cooperatives are prohibited from, upon renewal of a plan, reclassifying or changing premiums for individuals if the health status of the individual changes, excluding if premiums are changed or discounted based on activities in a wellness program. Plans offered in the secondary state must also be available in the primary state. Any state in the cooperative can require insurance issuers to receive a license to practice in that state. Individuals cannot buy health insurance in a secondary state if the plan's premiums in the primary state exceed 10% of the national average premium.

An independent review process of appealing denied claims must be created for individuals covered under individual health insurance in order for an insurer to provide coverage in a secondary state. Individuals on the review board must not have any familial, financial, professional, or other conflict of interest in the review process. Each individual must be a licensed physician who practices in the same field as the condition of the individual appealing the claim. In reviews relating to children, at least one reviewer must have expertise in pediatrics. Compensation provided by the insurer to the reviewer must be reasonable and not related to the reviewer's decision.

Title IV – Safety Net Reforms

Sections 401, 402, and 403 require state governments to disclose how they intend to cover at least 90% of eligible low-income children in government health care programs and group health plans, and to offer more than one health plan in SCHIP. States are prohibited from providing coverage to children with family income above 300% of the FPL. For children in families above 200%, states cannot pay for coverage unless they are currently providing and will continue to provide coverage to at least 90% of eligible children below 200% of the FPL. These requirements extend to pregnant women. Consideration of individuals' and families' income must be based on their gross, or pre-tax, income. Excluding requirements under Section 2102 of the Social Security Act, minimum coverage requirements and limitations on beneficiary cost-sharing do not apply to these group plans. If the plans do not cover immunizations, well-baby and well-child care, dental care, or emergency services, then SCHIPs must provide these benefits as supplemental benefits. Premium payments to group plans in a single fiscal year are to be restricted to a maximum of the product of the national per capita premium expenditure for the previous fiscal year, the Federal Medical Assistance Percentages (FMAP) for the state in that fiscal year, and the number of low-income children or pregnant women receiving coverage. Children are not to be enrolled unless the child's parent or guardian has been informed of the coverage and are given at least one opportunity per fiscal year to switch coverage. State health plans are required to state how they will notify potential beneficiaries, to provide such notification during applications for enrollment, and post a description of coverage options on a public website. Proof of enrollment for low-income children in a group health plan is to be made every six months. The per capita dollar amount paid by the state to the plan provider is required to be at least 90% of the value of the benefits and must be uniform across all plans offered.

Title V – Lawsuit Abuse Reforms

Section 501 instructs the HHS Secretary to issue "best practice" guidelines for medical care as part of a contract with a qualified consensus-building organization and in cooperation with physician specialty organizations. These guidelines are to be updated biennially and will be made publicly available over the internet. If a defendant in any health care lawsuit related to the treatment of an individual proves that the treatment was in compliance with the guidelines, then the defendant will not be held liable unless liability is otherwise demonstrated by the plaintiff. The guidelines cannot be introduced as evidence of negligence or deviation in standard any health care lawsuit unless previously introduced by the plaintiff. Health care providers will not be presumed negligent with respect to treatment if they are not in compliance with the guidelines.

Section 502 allows for grants to be awarded to states for the development, implementation, and evaluation of administrative health care tribunals to resolve disputes concerning injuries allegedly caused by health care providers. Before going to the tribunal, lawsuits would first be reviewed by an expert panel of three to seven licensed health care professionals or physicians of the same or similar specialty with respect to the lawsuit, so long as the panel's members have no material, familial, financial, or professional relationship with a party involved in the dispute. In disputes involving children, at least one member of the panel will have expertise in pediatrics. If the parties present in a dispute before the expert panel accept the determination of the panel concerning liability and compensation, then the compensation will be paid to the claimant and the claimant will forego any further legal action against the health care providers involved. If there is no agreement, the dispute is referred to the administrative health care tribunal. States are required to ensure that tribunals are composed of special judges with health care expertise, that the judges have the authority to make binding rules in written decisions on standards of care, causation, compensation, and related issues, to establish gross negligence as the legal standard for the tribunal, allow for the admission of evidence, and to provide for an appeals process for tribunal decisions to be reviewed by a state court. If either party is unsatisfied with the tribunal's decision, the party will enjoy the right to file their claim in a state court, but in doing so forfeit any compensation received during the tribunal process. Under section 503, damages equaling or exceeding $50,000 in a health care lawsuit can be paid back periodically instead of in full.

Title VI – Wellness and Prevention

Section 601 allows for premiums and cost-sharing in group health plans to vary by up to 50% of the value of the benefits of the plan based on participation, or lack thereof, in any standards-based wellness program.

Title VII – Transparency and Insurance Reform Measures

Section 701 aims to increase transparency in the process of claiming health insurance. Within 30 days, insurers are required to provide to the party requesting a claims report the information regarding aggregate paid claims experience by month, total premiums paid by month, total number of covered employees on a monthly basis by coverage tier, total dollar amount currently pending, and a description and individual claims report for individuals whose total paid claims exceed $15,000 during the 12 months before the date of the report. Within 10 days of receiving the report from the insurer, the party receiving the report can request for additional claims information, to which the insurer must respond by the 15th day. Insurers are not allowed to disclose any health information protected under HIPAA or stricter federal or state laws, but must disclose to the plan sponsor or administrator that protected health information is being withheld and why it is being withheld. Insurers are not obligated to provide reports to any particular employer more than twice in a 12-month time period or to any employer with fewer than 50 employees.

Title VIII – Quality

Section 801 prohibits HHS from using data collected from comparative effectiveness research or patient-centered outcomes research to deny coverage of an item or service under any federal health care program. These research methods conducted or financially supported by the federal government will have to account for differences in the treatment response and patients' treatment preferences, including patient-reported outcomes, genomics and personalized medicine, the unique needs of health disparity populations, and indirect patient benefits. Section 802 further directs the HHS Secretary to create a formalized process for the development of performance-based quality measures to apply to physician services under Medicare.

Title VIX – State Transparency Plan Portal

Section 901 allows for state governments to contract with a private entity to establish a "Health Plan and Provider Portal" website to standardize and make publicly available information regarding purchasable health insurance in the state, including price and coverage information. Portals cannot directly enroll individuals in health insurance plans or under a state Medicaid or SCHIP plan. Insurers cannot offer health insurance plans through the portal if they were involved in the creation of the portal or have an ownership interest in the plan portal. Individuals employed by insurers cannot serve as a director or officer for the private entity creating the portal or for the portal itself. With the exception of not being able to enroll in plans, the Act's portals are functionally similar to the health insurance exchanges of the PPACA.

Title X – Patient Freedom of Choice

Section 1001 rewrites section 1802 of the Social Security Act (section 5000A of the IRC) to allow for Medicare beneficiaries to contract with any health care professionals that provide care covered under the Medicare program. Participation in a contract would not automatically render the health care provider as a participating or non-participating provider under Medicare, so claim payments made to non-participating providers are to paid as if the provider is participating. Contracts are to include all terms of the contract and beneficiaries are not to be held liable for any payments made in excess of those outlined in the contract. By signing the contract, the beneficiary agrees to be responsible for payments to health care professionals for items and services agreed to under the contract, for submitting claims to the Secretary and supplemental insurance plans for items and services covered under Medicare, and acknowledges that no limits or other payment incentives that would otherwise apply under Medicare will apply to the amount charged or paid to a beneficiary for items and services. The contract cannot be entered into during a time in which the beneficiary is experiencing an emergency medical condition or urgent health care situation. Beneficiaries can choose to have, as part of the contract, a provision that would enable the health care professional to file claims and assign payments to the eligible professional on behalf of the beneficiary. Individuals eligible for both Medicare and Medicaid would not have access to this section's contract.

Section 1002 prohibits states, D.C., and the unincorporated organized territories of the United States from setting limits on the amount of charges for services provided by health care professionals.

Section 1003 prohibits the HHS Secretary and states from requiring any health care provider to participate in any health plan as a condition of licensure in that state.

Section 1004 creates an itemized tax deduction for certain physicians. Eligible physicians must be certified by the American Board of Emergency Medicine or another appropriate medical specialty board for the specialty in which the physician practices. The deduction can be claimed if the physician incurs debt as a result of the Emergency Medical Treatment and Active Labor Act (EMTALA) service requirements in a hospital required to comply with EMTALA. The amount of the deduction is to be equal to the Medicare fee schedule amount that would be received if the service were provided under Medicare Part B.

Section 1005 prohibits the HHS Secretary from preventing any enrollee, participant, or beneficiary of any health benefits plan, excluding for Medicaid and TRICARE, from entering into any contract or arrangement for health care with any health care provider.

Title XI – Incentives to Reduce Physician Shortages

Like the PPACA, title XI contains provisions authorizing loan and loan repayment programs for certain medical students and physicians, intended to address shortages of primary care physicians.

Title XII – Quality Health Care Coalition

Section 1201 exempts health care professionals who are negotiating the terms of contract of a health plan, under which the professionals provide care items or services for which benefits are provided under such plan, from antitrust laws. This exemption does not extend to health care professionals who are negotiating plans in Medicare, Medicaid, SCHIP, FEHBP, and the Veteran and Indian health systems. This exemption will not confer the right to participate in any collective cessation of services to patients not otherwise permitted under existing law.

Title XIII – Offsets