MCG17700 S.L.C. AMENDMENT NO.llll Calendar No.lll Purpose: In the nature of a substitute. IN THE SENATE OF THE UNITED STATES—115th Cong., 1st Sess. H. R. 1628 To provide for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017. Referred to the Committee on llllllllll and ordered to be printed Ordered to lie on the table and to be printed AMENDMENT IN THE NATURE OF A SUBSTITUTE intended to be proposed by lllllll Viz: 1 Strike all after the enacting clause and insert the fol- 2 lowing: 3 4 SECTION 1. SHORT TITLE. This Act may be cited as the ‘‘Health Care Freedom 5 Act’’. 6 7 8 TITLE I SEC. 101. INDIVIDUAL MANDATE. (a) IN GENERAL.—Section 5000A(c) of the Internal 9 Revenue Code of 1986 is amended— 10 11 12 (1) in paragraph (2)(B)(iii), by striking ‘‘2.5 percent’’ and inserting ‘‘Zero percent’’, and (2) in paragraph (3)— MCG17700 S.L.C. 2 1 2 (A) by striking ‘‘$695’’ in subparagraph (A) and inserting ‘‘$0’’, and 3 (B) by striking subparagraph (D). 4 (b) EFFECTIVE DATE.—The amendments made by 5 this section shall apply to months beginning after Decem6 ber 31, 2015. 7 8 SEC. 102. EMPLOYER MANDATE. (a) IN GENERAL.— 9 (1) Paragraph (1) of section 4980H(c) of the 10 Internal Revenue Code of 1986 is amended by in- 11 serting ‘‘($0 in the case of months beginning after 12 December 31, 2015, and before January 1, 2025)’’ 13 after ‘‘$2,000’’. 14 (2) Paragraph (1) of section 4980H(b) of the 15 Internal Revenue Code of 1986 is amended by in- 16 serting ‘‘($0 in the case of months beginning after 17 December 31, 2015, and before January 1, 2025)’’ 18 after ‘‘$3,000’’. 19 (b) EFFECTIVE DATE.—The amendments made by 20 this section shall apply to months beginning after Decem21 ber 31, 2015. MCG17700 S.L.C. 3 1 2 3 SEC. 103. EXTENSION OF MORATORIUM ON MEDICAL DEVICE EXCISE TAX. (a) IN GENERAL.—Section 4191(c) of the Internal 4 Revenue Code of 1986 is amended by striking ‘‘December 5 31, 2017’’ and inserting ‘‘December 31, 2020’’. 6 (b) EFFECTIVE DATE.—The amendment made by 7 this section shall apply to sales after December 31, 2017. 8 SEC. 104. MAXIMUM CONTRIBUTION LIMIT TO HEALTH SAV- 9 INGS ACCOUNT INCREASED TO AMOUNT OF 10 DEDUCTIBLE AND OUT-OF-POCKET LIMITA- 11 TION. 12 (a) IN GENERAL.—Subsection (b) of section 223 of 13 the Internal Revenue Code of 1986 is amended by adding 14 at the end the following new paragraph: 15 ‘‘(9) INCREASED LIMITATION.—In the case of 16 any month beginning after December 31, 2017, and 17 before January 1, 2021— 18 ‘‘(A) paragraph (2)(A) shall be applied by 19 substituting ‘the amount in effect under sub- 20 section (c)(2)(A)(ii)(I)’ for ‘$2,250’, and 21 ‘‘(B) paragraph (2)(B) shall be applied by 22 substituting ‘the amount in effect under sub- 23 section (c)(2)(A)(ii)(II)’ for ‘$4,500’.’’. 24 (b) EFFECTIVE DATE.—The amendment made by 25 this section shall apply to taxable years beginning after 26 December 31, 2017. MCG17700 S.L.C. 4 1 2 SEC. 105. FEDERAL PAYMENTS TO STATES. (a) IN GENERAL.—Notwithstanding section 504(a), 3 1902(a)(23), 1903(a), 2002, 2005(a)(4), 2102(a)(7), or 4 2105(a)(1) of the Social Security Act (42 U.S.C. 704(a), 5 1396a(a)(23), 1396b(a), 1397a, 1397d(a)(4), 6 1397bb(a)(7), 1397ee(a)(1)), or the terms of any Med7 icaid waiver in effect on the date of enactment of this Act 8 that is approved under section 1115 or 1915 of the Social 9 Security Act (42 U.S.C. 1315, 1396n), for the 1-year pe10 riod beginning on the date of enactment of this Act, no 11 Federal funds provided from a program referred to in this 12 subsection that is considered direct spending for any year 13 may be made available to a State for payments to a pro14 hibited entity, whether made directly to the prohibited en15 tity or through a managed care organization under con16 tract with the State. 17 18 (b) DEFINITIONS.—In this section: (1) PROHIBITED ENTITY.—The term ‘‘prohib- 19 ited entity’’ means an entity, including its affiliates, 20 subsidiaries, successors, and clinics— 21 22 (A) that, as of the date of enactment of this Act— 23 (i) is an organization described in sec- 24 tion 501(c)(3) of the Internal Revenue 25 Code of 1986 and exempt from tax under 26 section 501(a) of such Code; MCG17700 S.L.C. 5 1 (ii) is an essential community provider 2 described in section 156.235 of title 45, 3 Code of Federal Regulations (as in effect 4 on the date of enactment of this Act), that 5 is primarily engaged in family planning 6 services, reproductive health, and related 7 medical care; and 8 9 10 11 (iii) provides for abortions, other than an abortion— (I) if the pregnancy is the result of an act of rape or incest; or 12 (II) in the case where a woman 13 suffers from a physical disorder, phys- 14 ical injury, or physical illness that 15 would, as certified by a physician, 16 place the woman in danger of death 17 unless an abortion is performed, in- 18 cluding a life-endangering physical 19 condition caused by or arising from 20 the pregnancy itself; and 21 (B) for which the total amount of Federal 22 and State expenditures under the Medicaid pro- 23 gram under title XIX of the Social Security Act 24 in fiscal year 2014 made directly to the entity 25 and to any affiliates, subsidiaries, successors, or MCG17700 S.L.C. 6 1 clinics of the entity, or made to the entity and 2 to any affiliates, subsidiaries, successors, or 3 clinics of the entity as part of a nationwide 4 health 5 $1,000,000. 6 (2) DIRECT care provider network, SPENDING.—The exceeded term ‘‘direct 7 spending’’ has the meaning given that term under 8 section 250(c) of the Balanced Budget and Emer- 9 gency Deficit Control Act of 1985 (2 U.S.C. 900(c)). TITLE II 10 11 12 SEC. 201. THE PREVENTION AND PUBLIC HEALTH FUND. Subsection (b) of section 4002 of the Patient Protec- 13 tion and Affordable Care Act (42 U.S.C. 300u–11) is 14 amended— 15 (1) in paragraph (3), by striking ‘‘each of fiscal 16 years 2018 and 2019’’ and inserting ‘‘fiscal year 17 2018’’; and 18 19 20 (2) by striking paragraphs (4) through (8). SEC. 202. COMMUNITY HEALTH CENTER PROGRAM. Effective as if included in the enactment of the Medi- 21 care Access and CHIP Reauthorization Act of 2015 (Pub22 lic Law 114–10, 129 Stat. 87), paragraph (1) of section 23 221(a) of such Act is amended by inserting ‘‘, and an ad24 ditional $422,000,000 for fiscal year 2017’’ after ‘‘2017’’. MCG17700 S.L.C. 7 1 2 SEC. 203. WAIVERS FOR STATE INNOVATION. Section 1332 of the Patient Protection and Afford- 3 able Care Act (42 U.S.C. 18052) is amended— 4 (1) in subsection (a)(3)— 5 (A) in the first sentence, by inserting ‘‘or 6 would qualify for a reduction in’’ after ‘‘would 7 not qualify for’’; 8 (B) by adding after the second sentence 9 the following: ‘‘A State may request that all of, 10 or any portion of, such aggregate amount of 11 such credits or reductions be paid to the State 12 as described in the first sentence.’’; 13 (C) in the paragraph heading, by striking 14 ‘‘PASS 15 ‘‘FUNDING’’; 16 17 18 19 THROUGH OF FUNDING’’ and inserting (D) by striking ‘‘With respect’’ and inserting the following: ‘‘(A) PASS THROUGH OF FUNDING.—With respect’’; and 20 (E) by adding at the end the following: 21 ‘‘(B) ADDITIONAL FUNDING.—There is au- 22 thorized to be appropriated, and is appro- 23 priated, to the Secretary of Health and Human 24 Services, out of monies in the Treasury not oth- 25 erwise obligated, $2,000,000,000, to remain 26 available until the end of fiscal year 2019. Such MCG17700 S.L.C. 8 1 amounts shall be used to provide grants to 2 States that request financial assistance for the 3 purpose of— 4 ‘‘(i) submitting an application for a 5 waiver granted under this section; or 6 ‘‘(ii) implementing the State plan 7 8 9 under such waiver.’’; (2) in subsection (b)(1), in the matter preceding subparagraph (A)— 10 11 (A) by striking ‘‘may’’ and inserting ‘‘shall’’; and 12 13 14 (B) by striking ‘‘only’’; (3) in subsection (d)(1), by striking ‘‘180’’ and inserting ‘‘45’’; and 15 (4) in subsection (e), by striking ‘‘No waiver’’ 16 and all that follows through the period at the end 17 and inserting the following: ‘‘A waiver under this 18 section— 19 20 21 22 ‘‘(1) shall be in effect for a period of 8 years unless the State requests a shorter duration; ‘‘(2) may be renewed for unlimited additional 8year periods upon application by the State; and 23 ‘‘(3) may not be cancelled by the Secretary be- 24 fore the expiration of the 8-year period (including 25 any renewal period under paragraph (2)).’’.