,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #dcid  ,,in ,,the ,,house ,,of  
,,representatives  ,november #ad1       
#bjag,ms4 ,titus introduced the         
following bill2 which was referred to   
the ,committee on ,energy and ,commerce 
,a ,,bill  ,to direct the ,secretary of 
,health and ,human ,services to make    
available a public option for health    
insurance coverage for individuals      
residing in an area without a qualified 
health plan available through an        
,exchange1 and for other purposes4  #a4 
,short title ,this ,act may be cited as 
the ,bare ,county ,buy-in ,act of #bjag4
  #b4 ,public option for health         
insurance coverage  7a7 ,in general     
,part #b of subtitle ,d of title ,i of  
the ,patient ,protection and ,affordable
 ,care ,act 7,public ,law #aaa-adh7 is  
amended by adding at the end the        
following new section3  #acad4 ,public  
option for health insurance coverage    
7a7 ,in general ,if the ,secretary      
determines that individuals residing in 

a rating area 7as described in section  
#bgja7;a7 of the ,public ,health        
,service ,act 7#db ,u4,s4,c4            
#cjj;gg7a777 eligible to purchase       
individual health insurance coverage    
through an ,exchange will not have      
access to a qualified health plan       
offered through an ,exchange in the     
individual market with respect to a plan
 year beginning on or after ,january #a1
 #bjah1 the ,secretary shall make       
available the public option for health  
insurance coverage described in         
subsection 7b7 7in this section referred
 to as the public option7 to such       
individuals through such ,exchange for  
such plan year4  7b7 ,public option     
requirements ,the public option         
described in subsection 7a7 shall-- 7#a7
 provide the essential health benefits  
package 7as defined in section          
#acjb7;a772  7#b7 comply with the       
requirements of this title and the      
amendments made by this title1 to the   
extent practicable1 applicable to a     

health plan offered through an          
,exchange2 and  7#c7 consist of a plan  
in the silver level of coverage 7as     
described in section #acjb7;d774  7c7   
,enrollment and coverage periods ,the   
,secretary shall establish enrollment   
and coverage periods for individuals who
 enroll in the public option4 ,such     
periods shall be established1 to the    
extent practicable1 in coordination with
 the enrollment and coverage periods for
 other plans offered through an         
,exchange4  7d7 ,premiums  7#a7 ,monthly
 premium ,the ,secretary shall determine
 a monthly premium for individuals      
enrolled in the public option4 ,such    
monthly premium shall be equal to #a_/ab
 of the annual premium computed under   
paragraph 7#b77;,b74  7#b7 ,annual      
premium  7,a7 ,estimation ,the          
,secretary shall estimate the average1  
annual per capita amount for benefits   
and administrative expenses payable     
under this section for individuals in   
each age band specified in subparagraph 

7,c7 enrolled in the public option4     
7,b7 ,computation ,the annual premium   
under this subsection for months in a   
year is equal to the average1 annual per
 capita amount estimated under paragraph
 7#a7 for the year for each age band    
specified in subparagraph 7,c71         
geographically adjusted by rating area4 
7,c7 ,age bands ,the age bands specified
 in this subparagraph are the age bands 
defined by the ,secretary pursuant to   
section #bgja7;a77#c7 of the ,public    
,health ,service ,act 7#db ,u4,s4,c4    
#cjj;gg7a77#c774  7#c7 ,variation in    
premium rates ,the premium rate charged 
for the public option may not vary      
except as provided under section #bgja  
of such ,act 7#db ,u4,s4,c4 #cjj;gg74   
7e7 ,payment of premiums  7#a7 ,in      
general ,premiums for enrollment in the 
public option shall be paid to the      
,secretary at such times1 and in such   
manner1 as the ,secretary determines    
appropriate4  7#b7 ,deposit ,amounts    
collected by the ,secretary under this  

section shall be deposited in the       
account established under subsection    
7f74  7f7 ,account  7#a7 ,establishment 
,there is established in the ,treasury  
of the ,united ,states an account for   
the receipts and disbursements          
attributable to the operation of the    
public option4  7#b7 ,prohibition of    
,state imposition of taxes ,section     
#ahed7;g7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #aciew-#bd7;g77 shall    
apply to receipts and disbursements     
described in paragraph 7#a7 in the same 
manner as such section applies to       
payments or premiums described in such  
section4  7g7 ,health care provider     
payment rates for items and services    
7#a7 ,in general  7,a7 ,rates negotiated
 by the ,secretary ,subject to          
subparagraph 7,b71 the ,secretary shall1
 through a negotiated agreement with    
health care providers1 establish rates  
for reimbursing health care providers   
for providing the benefits covered by   
the public option4  7,b7 ,medicare      

reimbursement rates ,if the ,secretary  
and health care providers are unable to 
reach a negotiated agreement on a       
reimbursement rate1 the ,secretary shall
 reimburse providers at rates determined
 for equivalent items and services under
 the original ,medicare fee-for-service 
program under parts ,a and ,b of title  
,,xviii of the ,social ,security ,act4  
7,c7 ,for new services ,the ,secretary  
shall modify reimbursement rates        
described in subparagraph 7,b7 in order 
to accommodate payments for services    
that are not otherwise covered under the
 original medicare fee-for-service      
program4  7#b7 ,prescription drugs ,any 
payment rate under this subsection for a
 prescription drug shall be at a rate   
negotiated by the ,secretary4 ,if the   
,secretary is unable to reach a         
negotiated agreement on such a          
reimbursement rate1 the ,secretary shall
 use rates determined for equivalent    
drugs paid for under the original       
medicare fee-for-service program4 ,the  

,secretary shall modify such rates in   
order to accommodate payments for drugs 
that are not otherwise covered under the
 original medicare fee-for-service      
program4  7h7 ,health care provider     
participation  7#a7 ,provider           
participation  7,a7 ,in general ,the    
,secretary shall establish conditions of
 participation for health care providers
 under the public option4  7,b7         
,licensure or certification ,the        
,secretary shall not allow a health care
 provider to participate in the public  
option unless such provider is          
appropriately licensed or certified     
under ,state law4  7#b7 ,establishment  
of a provider network  7,a7 ,medicare   
and ,medicaid participating providers ,a
 health care provider that is a         
participating provider of services or   
supplier under the ,medicare program    
under title ,,xviii of the ,social      
,security ,act or under a ,state        
,medicaid plan under title ,,xix of such
 ,act is a participating provider in the

 public option unless the health care   
provider opts out of participating in   
the public option through a process     
established by the ,secretary4  7,b7    
,additional providers ,the ,secretary   
shall establish a process to allow      
health care providers not described in  
subparagraph 7,a7 to become             
participating providers in the public   
option4  7i7 ,administrative contracting
  7#a7 ,authorities ,the ,secretary may 
enter into contracts for the purpose of 
performing administrative functions     
7including functions described in       
subsection 7a77#d7 of section #ahgd;,a  
of the ,social ,security ,act7 with     
respect to the public option in the same
 manner as the ,secretary may enter into
 contracts under subsection 7a77#a7 of  
such section4 ,the ,secretary shall have
 the same authority with respect to the 
public option as the ,secretary has     
under such subsection 7a77#a7 and       
subsection 7b7 of section #ahgd;,a of   
the ,social ,security ,act with respect 

to title ,,xviii of such ,act4  7#b7    
,transfer of insurance risk ,any        
contract under this paragraph shall not 
involve the transfer of insurance risk  
from the ,secretary to the entity       
entering into such contract with the    
,secretary4  4  7b7 ,conforming         
amendments  7#a7 ,treatment as a        
qualified health plan ,section          
#acja7;a77#b7 of the ,patient           
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #ahjba7;a77#b77 is       
amended--  7,a7 in the paragraph        
heading1 by inserting 81 ,,the ,,public 
,,health ,,insurance ,,option10 before  
8and02 and  7,b7 by inserting 8the      
public health insurance option under    
section #acad10 before 8and a           
multi-,state plan04  7#b7 ,state        
insurance regulation ,section #acbd7;a7 
of the ,patient ,protection and         
,affordable ,care ,act 7#db ,u4,s4,c4   
#ahjdd7;a77 is amended by inserting 8the
 public health insurance option under   
section #bgie of the ,public ,health    

,service ,act10 before 8or a            
multi-,state qualified health plan04