,,ii  #aacth ,,congress  #ast ,session  
,s4 #adfi  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,august #a1    
#bjac ,mr4 ,paul introduced the         
following bill2 which was read twice and
 referred to the ,committee on ,finance 
,a ,,bill  ,to provide higher-quality1  
lower-cost health care to seniors4  #a4 
,short title ,this ,act may be cited as 
the ,congressional ,health ,care for    
,seniors ,act of #bjac4  #b4 ,enrolling 
seniors in the same health care plans as
 ,members of ,congress  7a7 ,in general 
,chapter #hi of title #e1 ,united       
,states ,code1 is amended--  7#a7 in    
section #hija--  7,a7 in paragraph      
7#aj71 by striking and at the end2  7,b7
 in paragraph 7#aa71 by striking the    
period at the end and inserting 2 and2  
and  7,c7 by adding at the end the      
following3  7#ab7 the term covered      
individual means an individual who1     
taking into account section #bbf7k7 of  
the ,social ,security ,act1 would have  
been entitled to1 or could have enrolled

 for1 benefits under part ,a of title   
,,xviii of such ,act or could have      
enrolled under part ,b of such title if 
section #ahii;,b had not been enacted4  
2  7#b7 by inserting after section #hija
 the following3  ,i ,federal employees  
2  7#c7 in section #hijb--  7,a7 in     
subsection 7a7--  7i7 by inserting 7#a7 
after 7a72 and  7ii7 by adding at the   
end the following3  7#b7 7,a7 ,in this  
paragraph1 the term equivalent health   
benefits plan means a health benefits   
plan proposed to be provided that offers
 benefits that the ,director of the     
,office of ,personnel ,management       
determines are substantially equivalent 
or superior to benefits offered under1  
and does not impose requirements that   
are substantially different than        
requirements under1 a health benefits   
plan in which an employee could enroll  
on the date of enactment of the         
,congressional ,health ,care for        
,seniors ,act of #bjac if the employee  
resided--  7i7 anywhere in the ,united  

,states2 or  7ii7 in the same region of 
the ,united ,states as the health       
benefits plan proposed to be provided4  
7,b7 ,for contract years beginning on or
 after ,january #a1 #bjae1 if a carrier 
offers to provide an equivalent health  
benefits plan1 the ,director shall enter
 into a contract with the carrier to    
provide the equivalent health benefits  
plan4  2  7,b7 in subsection 7e71 by    
striking ,the ,office may prescribe and 
inserting ,subject to subsection        
7a77#b71 the ,office may prescribe2 and 
7,c7 by adding at the end the following3
  7p7 ,a contract under this chapter for
 a contract year beginning on or after  
,january #a1 #bjae1 shall offer benefits
 for employees1 annuitants1 members of  
their families1 former spouses1 persons 
having continued coverage under section 
#hije;a of this title1 and covered      
individuals4 ,in administering this     
subchapter and subchapter ,,ii1         
employees1 annuitants1 members of their 
families1 former spouses1 persons having

 continued coverage under section       
#hije;a of this title1 and covered      
individuals shall be in the same risk   
pool4  2  7#d7 in section #hijd--  7,a7 
by striking 7a7 ,the benefits and       
inserting ,the benefits2  7,b7 by       
striking this subsection each place it  
appears and inserting this section2 and 
7,c7 by striking subsection 7b72  7#e7  
in section #hiji7;a77#a71 by inserting  
and for all payments under section      
#hiba7;d7 before the semicolon2  7#f7 in
 section #hiaj1 by striking subsection  
7d72 and  7#g7 by adding at the end the 
following3  ,,ii ,covered individuals   
#hiba4 ,health insurance for covered    
individuals  7a7 ,for contract years    
beginning on or after ,january #a1      
#bjae1 and except as otherwise provided 
in this subchapter1 the ,director of the
 ,office of ,personnel ,management shall
 ensure that to the greatest extent     
possible health benefits plans provide  
benefits for covered individuals to the 
same extent and in the same manner as   

provided under subchapter ,i for        
employees1 annuitants1 members of their 
families1 former spouses1 and persons   
having continued coverage under section 
#hije;a of this title4  7b7 7#a7 ,the   
,director shall establish the deadline  
by which a covered individual shall     
elect to--  7,a7 enroll in a health     
benefits plan under this chapter based  
on the status of the individual as a    
covered individual2  7,b7 with the      
concurrence of the employer or former   
employer of the covered individual1     
receive payments under subsection 7d7 to
 assist in paying for health insurance  
provided through the employer or former 
employer of the covered individual2 or  
7,c7 not enroll in a health benefits    
plan or receive payments under this     
chapter4  7#b7 ,failure to make a timely
 election under this subsection shall be
 deemed as an election to not enroll in 
a health benefits plan or receive       
payment under this chapter4  7#c7 ,a    
covered individual--  7,a7 may elect to 

enroll in a health benefits plan as an  
individual2 and  7,b7 may not enroll in 
a health benefits plan for self and     
family4  7#d7 7,a7 ,a covered individual
 who elects not to enroll1 or who elects
 not to continue enrollment1 in a health
 benefits plan under this chapter       
7including a covered individual who     
elects to receive payments under        
subsection 7d77 may subsequently enroll 
in a health benefits plan under this    
chapter based on the status of the      
covered individual as a covered         
individual in accordance with such      
procedures1 and after paying such fees1 
as the ,director of the ,office of      
,personnel ,management may establish4   
7,b7 ,the fact that a covered individual
 elects not to enroll1 or elects not to 
continue enrollment1 in a health        
benefits plan under this chapter shall  
not affect the eligibility of the       
covered individual for benefits under   
title ,,ii of the ,social ,security ,act
 7#db ,u4,s4,c4 #dja et seq474  7c7 7#a7

 7,a7 ,a covered individual who elects  
to enroll in a health benefits plan     
under this chapter based on the status  
of the covered individual as a covered  
individual shall pay a monthly          
individual premium payment determined in
 accordance with subparagraph 7,b74     
7,b7 ,the individual premium payment    
under subparagraph 7,a7 shall be        
determined based on income1 as follows3 
7i7 ,for an individual with an adjusted 
gross income 7as defined under section  
#fb of the ,internal ,revenue ,code of  
#aihf7 of not more than #he1jjj1 the    
individual premium payment shall be in  
an amount equal to the employee         
contribution for the health benefits    
plan1 as determined under section #hijf4
  7ii7 ,for an individual with an       
adjusted gross income of more than      
#he1jjj and not more than #ajg1jjj1 the 
individual premium payment shall be in  
an amount equal to the sum of--  7,i7   
the employee contribution for the health
 benefits plan1 as determined under     

section #hijf2 and  7,,ii7 the product  
obtained by multiplying--  7aa7 the     
,government contribution 7as determined 
under section #hijf7;b772 by  7bb7      
#j4je4  7iii7 ,for an individual with an
 adjusted gross income of more than     
#ajg1jjj and not more than #afj1jjj1 the
 individual premium payment shall be in 
an amount equal to the sum of--  7,i7   
the employee contribution for the health
 benefits plan1 as determined under     
section #hijf2 and  7,,ii7 the product  
obtained by multiplying--  7aa7 the     
,government contribution 7as determined 
under section #hijf7;b772 by  7bb7 #j4a4
  7iv7 ,for an individual with an       
adjusted gross income of more than      
#afj1jjj and not more than #bej1jjj1 the
 individual premium payment shall be in 
an amount equal to the sum of--  7,i7   
the employee contribution for the health
 benefits plan1 as determined under     
section #hijf2 and  7,,ii7 the product  
obtained by multiplying--  7aa7 the     
,government contribution 7as determined 

under section #hijf7;b772 by  7bb7      
#j4ae4  7v7 ,for an individual with an  
adjusted gross income of more than      
#bej1jjj and not more than #a1jjj1jjj1  
the individual premium payment shall be 
in an amount equal to the sum of--  7,i7
 the employee contribution for the      
health benefits plan1 as determined     
under section #hijf2 and  7,,ii7 the    
product obtained by multiplying--  7aa7 
the ,government contribution 7as        
determined under section #hijf7;b772 by 
7bb7 #j4e4  7vi7 ,for an individual with
 an adjusted gross income of more than  
#a1jjj1jjj1 the individual premium      
payment shall be in an amount equal to  
the sum of--  7,i7 the employee         
contribution for the health benefits    
plan1 as determined under section #hijf2
 and  7,,ii7 the ,government            
contribution 7as determined under       
section #hijf7;b774  7,c7 ,the ,director
 of the ,office of ,personnel           
,management shall adjust the income     
amounts under subparagraph 7,b7 annually

 to reflect changes in the ,consumer    
,price ,index for all ,urban ,consumers 
published by the ,department of ,labor4 
7#b7 7,a7 ,for a covered individual who 
is entitled to monthly benefits under   
section #bjb or #bbc of the ,social     
,security ,act 7#db ,u4,s4,c4 #djb and  
#dbc71 the monthly premiums of the      
covered individual under this subchapter
 shall 7except as provided in           
subparagraph 7,b7 or 7,c77 be collected 
by deducting the amount of the premium  
from the amount of such monthly         
benefits4  7,b7 ,for a covered          
individual who is entitled to receive   
for a month an annuity under the        
,railroad ,retirement ,act of #aigd     
7whether or not the covered individual  
is also entitled for such month to a    
monthly insurance benefit under section 
#bjb of the ,social ,security ,act 7#db 
,u4,s4,c4 #djb771 the monthly premiums  
of the covered individual under this    
subchapter shall 7except as provided in 
subparagraph 7,c77 be collected by      

deducting the amount thereof from such  
annuity or pension4  7,c7 ,if a covered 
individual to whom subparagraph 7,a7 or 
7,b7 applies estimates that the amount  
which will be available for deduction   
under such subparagraph for any premium 
payment period will be less than the    
amount of the monthly premiums for such 
period1 the covered individual may pay  
to the ,director of the ,office of      
,personnel ,management such portion of  
the monthly premiums for such period as 
the covered individual desires4  7,d7   
,for a covered individual who is not    
described in subparagraph 7,a7 or 7,b7  
and who elects to enroll in a health    
benefits plan under this chapter1 or    
with respect to whom subparagraph 7,c7  
applies1 the covered individual shall   
pay monthly premiums to the ,director of
 the ,office of ,personnel ,management  
at such times1 and in such manner1 as   
the ,director shall by regulations      
prescribe4  7,e7 ,amounts deducted or   
paid under this paragraph shall be      

deposited in the ,treasury to the credit
 of the ,employees ,health ,benefits    
,fund established under section #hiji4  
7,f7 ,after consultation with the       
,director of the ,office of ,personnel  
,management1 the ,secretary of ,health  
and ,human ,services shall establish    
procedures for making and depositing    
deductions under this paragraph4  7#c7  
,the ,director of the ,office of        
,personnel ,management shall establish  
procedures for terminating the          
enrollment of a covered individual in a 
health benefits plan if the covered     
individual fails to make timely payment 
of premiums1 which shall allow such a   
covered individual to reenroll in a     
health benefits plan under such terms   
and conditions as the ,director may     
prescribe4  7d7 ,the ,director of the   
,office of ,personnel ,management shall 
make periodic payments to the employer  
or former employer providing health     
insurance to a covered individual who   
makes an election under subsection      

7b77#a77;,b7 in a total amount not to   
exceed the lesser of--  7#a7 the cost to
 the employer or former employer of     
providing health insurance to the       
covered individual2 and  7#b7 the       
average ,government contribution for an 
individual enrolled in a health benefits
 plan under this chapter that is        
available to individuals residing       
anywhere in the ,united ,states4  7e7   
,for fiscal year #bjae and each fiscal  
year thereafter1 there are appropriated 
to the ,employees ,health ,benefits     
,fund established under section #hiji1  
out of any funds in the ,treasury not   
otherwise appropriated--  7#a7 an amount
 equal to--  7,a7 the taxes imposed by  
sections #caja7;b7 and #caaa7;b7 of the 
,internal ,revenue ,code of #aihf with  
respect to wages reported to the        
,secretary of the ,treasury pursuant to 
subtitle ,f of such ,code after         
,december #ca1 #bjad1 as determined by  
the ,secretary of the ,treasury by      
applying the applicable rates of tax    

under such sections to such wages1 which
 wages shall be certified by the        
,commissioner of ,social ,security on   
the basis of records of wages           
established and maintained by the       
,commissioner of ,social ,security in   
accordance with such reports2  7,b7 the 
taxes imposed by section #adja7;b7 of   
the ,internal ,revenue ,code of #aihf   
with respect to self-employment income  
reported to the ,secretary of the       
,treasury on tax returns under subtitle 
,f of such ,code1 as determined by the  
,secretary of the ,treasury by applying 
the applicable rate of tax under such   
section to such self-employment income1 
which self-employment income shall be   
certified by the ,commissioner of       
,social ,security on the basis of       
records of self-employment established  
and maintained by the ,commissioner of  
,social ,security in accordance with    
such returns2 and  7,c7 any amounts     
that1 on or after ,january #a1 #bjae1   
are to be deposited in the ,federal     

,hospital ,insurance ,trust ,fund       
established under section #ahag of the  
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i7 under any other provision of   
law2 and  7#b7 a ,government            
contribution equal to the difference    
obtained by subtracting--  7,a7 the sum 
of--  7i7 the total amount of premiums  
paid by covered individuals under       
subsection 7c77#b7 for the fiscal year2 
and  7ii7 the amount appropriated under 
paragraph 7#a72 from  7,b7 the sum of-- 
7i7 the total cost for the fiscal year  
of subscription charges for health      
benefits plans for covered individuals  
enrolled in a health benefits plan based
 on the status of the covered           
individuals as covered individuals2 and 
7ii7 the total amount of payments for   
the fiscal year under subsection 7d74   
7f7 ,the ,director of the ,office of    
,personnel ,management shall establish1 
in consultation with the ,secretary of  
,health and ,human ,services acting     
through the ,administrator of the       

,centers for ,medicare  ,medicaid       
,services1 procedures to ensure that    
health benefits plans coordinate with   
,state ,medicaid programs with respect  
to the provision of cost-sharing and    
other medical assistance for covered    
individuals enrolled in health benefit  
plans who are also eligible for medical 
assistance and enrolled in a ,state     
,medicaid program4  ,,iii ,coverage of  
high risk individuals  #hida4           
,reimbursement of costs for high risk   
individuals  7a7 ,in this section1 the  
term high risk individual means an      
individual identified under subsection  
7b77#a74  7b7 ,after the end of each    
contract year beginning on or after     
,january #a1 #bjae1 the ,director of the
 ,office of ,personnel ,management      
shall--  7#a7 identify1 for the contract
 year1 individuals who--  7,a7 enrolled 
in a health benefits plan under this    
chapter for a contract year2 and  7,b7  
who1 of all individuals enrolled in a   
health benefits plan under this chapter 

for the contract year1 are in the       
highest #e percent in terms of benefits 
paid by a carrier under a health        
benefits plan relating to the contract  
year2 and  7#b7 pay to a carrier        
contracting to provide a health benefits
 plan to a high risk individual for the 
contract year #ij percent of the        
benefits paid by the carrier relating to
 the high risk individual4  7c7 7#a7    
,for fiscal year #bjae and each fiscal  
year thereafter1 there are appropriated 
to the ,director of the ,office of      
,personnel ,management from the ,federal
 ,hospital ,insurance ,trust ,fund      
established under section #ahag of the  
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i7 such sums as are necessary to  
carry out this section4  7#b7 ,if the   
amounts appropriated under paragraph    
7#a7 are insufficient to carry out this 
section1 for fiscal year #bjae and each 
fiscal year thereafter1 there are       
appropriated to the ,director of the    
,office of ,personnel ,management1 out  

of any funds in the ,treasury not       
otherwise appropriated1 such sums as are
 necessary to carry out this section4  4
  7b7 ,exemption from insurance         
requirements  7#a7 ,amendment to title  
#e ,chapter #hi of title #e1 ,united    
,states ,code1 is amended by inserting  
after section #hija the following3      
#hija;,a4 ,exemption from insurance     
requirements ,title ,i of the ,patient  
,protection and ,affordable ,care ,act1 
subtitle ,a of title ,x of such ,act1   
and the amendments made by such title ,i
 and subtitle ,a shall not apply to     
health benefits plans4  4  7#b7         
,conforming amendment ,section #bgji of 
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #cjj;gg-#h7 7as added by      
section #ajajc of the ,patient          
,protection and ,affordable ,care ,act7 
is amended--  7,a7 by striking          
subsection 7g72 and  7,b7 by            
redesignating subsection 7h7 as         
subsection 7g74  7c7 ,technical and     
conforming amendments ,chapter #hi of   

title #e1 ,united ,states ,code1 is     
amended--  7#a7 in the table of         
sections--  7,a7 by inserting after the 
item relating to section #hija the      
following3  #hija;,a4 ,exemption from   
insurance requirements4 ,,subchapter    
,i--,federal employees  2  and  7,b7 by 
adding at the end the following3        
,,subchapter ,,ii--,covered individuals 
#hiba4 ,health insurance for covered    
individuals4 ,,subchapter               
,,iii--,coverage of high risk           
individuals #hida4 ,reimbursement of    
costs for high risk individuals4  2     
7#b7 in section #hijb;a7d77#a7--  7,a7  
in subparagraph 7,a71 by adding or at   
the end2  7,b7 by striking subparagraph 
7,b72 and  7,c7 by redesignating        
subparagraph 7,c7 as subparagraph 7,b72 
and  7#c7 by striking section #hiaj7;d74
  7d7 ,effective date2 applicability    
,the amendments made by this section    
shall take effect on the date of        
enactment of this ,act and apply on and 
after ,january #a1 #bjae4  #c4          

,transitioning ,medicare patients to    
coverage under the ,federal ,employees  
,health ,benefits ,program  7a7         
,increase in ,medicare eligibility age  
,section #bbf of the ,social ,security  
,act 7#db ,u4,s4,c4 #dbf7 is amended by 
adding at the end the following new     
subsection3  7k7 ,increasing ,medicare  
qualifying age  7#a7 ,in general        
,notwithstanding any other provision of 
law1 any reference in this section1     
title ,,xviii1 or title ,,xix 7insofar  
as it relates to the eligibility age for
 ,medicare benefits under title ,,xviii7
 to age #fe shall be deemed a reference 
to the ,medicare qualifying age         
specified in paragraph 7#b74  7#b7      
,medicare qualifying age specified ,the 
,medicare qualifying age specified in   
this paragraph is determined as follows3
  7,a7 ,in the case of an individual who
 attains #fe years of age before        
,january #a1 #bjae1 the ,medicare       
qualifying age is #fe years of age4     
7,b7 ,in the case of an individual who  

attains #fe years of age in a year after
 #bjad1 and before #bjce1 the ,medicare 
qualifying age is the ,medicare         
qualifying age specified in this        
paragraph for the previous year         
increased by #c months4  7,c7 ,in the   
case of an individual who attains #fe   
years of age in a year after #bjcd1 the 
,medicare qualifying age is #gj years of
 age plus the number of months in the   
age increase factor 7as determined under
 paragraph 7#c774  7#c7 ,age increase   
factor ,the ,commissioner of ,social    
,security shall determine 7using        
reasonable actuarial assumptions7 and   
publish on or before ,november #a of    
each calendar year after #bjcc the      
number of months 7rounded1 if not a     
multiple of one month1 to the next lower
 multiple of one month7 by which life   
expectancy as of ,october #a of such    
calendar year of an individual attaining
 age #fe on such ,october #a exceeds the
 life expectancy as of ,october #a1     
#bjcd1 of an individual attaining age   

#fe on ,october #a1 #bjcd4 ,with respect
 to an individual who attains age #fe in
 the calendar year following any        
calendar year in which a determination  
is made under this paragraph1 the age   
increase factor shall be the number of  
months determined under this paragraph  
as of ,october #a of such calendar year 
in which such determination is made4  4 
7b7 ,sunset ,title ,,xviii of the       
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 is amended by adding at  
the end the following new section3      
#ahii;,b4 ,sunset of ,medicare program  
with transition to coverage under the   
,federal ,employees ,health ,benefits   
,program ,notwithstanding any other     
provision of law1 on and after ,january 
#a1 #bjae1 the following rules shall    
apply3  7#a7 ,the preceding provisions  
of this title shall not apply4  7#b7 ,no
 payments for items and services        
furnished under this title after such   
date shall be made4 ,no additional1     
bonus1 or incentive payments under this 

title1 such as graduate medical         
education payments1 may be made4  7#c7  
,payments for items and services        
furnished under this title prior to such
 date shall be made in the same manner  
as if this section had not been enacted4
  7#d7 ,all ,medicare supplemental      
policies under section #ahhb are        
terminated4  7#e7 ,all demonstration    
projects conducted under this title are 
terminated4  7#f7 ,entitlement to health
 benefits for individuals who1 but for  
this section 7and taking into account   
section #bbf7k771 would have been       
entitled to1 or could have enrolled for1
 benefits under part ,a or could have   
enrolled under part ,b shall be through 
enrollment in a health benefits plan    
under chapter #hi of title #e1 ,united  
,states ,code4  7#g7 ,at a date         
determined appropriate by the ,secretary
 7after payments described in paragraph 
7#c7 have been made71 amounts in the    
,federal ,hospital ,insurance ,trust    
,fund and the ,federal ,supplementary   

,medical ,insurance ,trust ,fund        
7including the ,medicare ,prescription  
,drug ,account within such ,trust ,fund7
 shall be transferred to the ,employees 
,health ,benefits ,fund established     
under section #hiji of chapter #e1      
,united ,states ,code4  7#h7 ,any       
determination under ,federal law 7other 
than this title and title ,,ii7 relating
 to ,medicare eligibility shall be made 
based on whether an individual is a     
covered individual1 as defined in       
section #hija of title #e1 ,united      
,states ,code4  4  7c7 ,conforming      
amendment  7#a7 ,section #bbf of the    
,social ,security ,act 7#db ,u4,s4,c4   
#dbf71 as amended by subsection 7a71 is 
amended by adding at the end the        
following new subsection3  7l7          
,notwithstanding the preceding          
provisions of this section1 on and after
 ,january #a1 #bjae1 entitlement to     
health benefits to individuals who1 but 
for this subsection and section         
#ahii;,b1 would have been entitled to   

benefits under part ,a and eligible to  
enroll under part ,b of title ,,xviii   
pursuant to this section shall be       
through enrollment in a health benefits 
plan under chapter #hi of title #e1     
,united ,states ,code1 rather than under
 title ,,xviii of this ,act4  4  7#b7   
,section #bbf;,a of the ,social         
,security ,act 7#db ,u4,s4,c4 #dbf7 is  
amended by adding at the end the        
following new subsection3  7d7          
,notwithstanding the preceding          
provisions of this section1 on and after
 ,january #a1 #bjae1 entitlement to     
health benefits to individuals who1 but 
for this subsection and section         
#ahii;,b1 would have been entitled to   
benefits under part ,a and eligible to  
enroll under part ,b of title ,,xviii   
pursuant to this section shall be       
through enrollment in a health benefits 
plan under chapter #hi of title #e1     
,united ,states ,code1 rather than under
 title ,,xviii of this ,act4  4  7d7    
,recommendations to ,states ,not later  

than #a year after the date of the      
enactment of this ,act1 the ,secretary  
of ,health and ,human ,services shall   
make available to ,states               
recommendations with respect to         
requirements for health care entities   
and individuals under the ,medicare     
program that1 by reason of section      
#ahii;,b of the ,social ,security ,act1 
as added by subsection 7b71 will no     
longer apply but that should be         
considered on the ,state level4