,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #dcid  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,novemb] #ad1         
#bjag,ms4 ,titus introduc$ ! foll[+     
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce  ,a ,,bill  ,to direct
 ! ,secret>y ( ,heal? & ,human ,s]vices 
to make available a public option =     
heal? insurance cov]age = individuals   
resid+ 9 an area )\t a qualifi$ heal?   
plan available ?r\gh an ,ex*ange1 & =   
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,b>e ,c\nty ,buy-9 ,act
 ( #bjag4  #b4 ,public option = heal?   
insurance cov]age  7a7 ,9 g5]al ,"p #b (
 subtitle ,d ( title ,i ( ! ,pati5t     
,protection & ,af=dable ,c>e ,act       
7,public ,law #aaa-adh7 is am5d$ by add+
 at ! end ! foll[+ new section3  #acad4 
,public option = heal? insurance cov]age
  7a7 ,9 g5]al ,if ! ,secret>y det]m9es 
t individuals resid+ 9 a rat+ area 7z   
describ$ 9 section #bgja7;a7 ( ! ,public
 ,heal? ,s]vice ,act 7#db ,u4,s4,c4     
#cjj;gg7a777 eligible to pur*ase        

individual heal? insurance cov]age ?r\gh
 an ,ex*ange w n h access to a qualifi$ 
heal? plan (f]$ ?r\gh an ,ex*ange 9 !   
individual m>ket ) respect to a plan ye>
 beg9n+ on or aft] ,janu>y #a1 #bjah1 ! 
,secret>y %all make available ! public  
option = heal? insurance cov]age        
describ$ 9 subsection 7b7 79 ?is section
 ref]r$ to z ! public option7 to su*    
individuals ?r\gh su* ,ex*ange = su*    
plan ye>4  7b7 ,public option           
requirem5ts ,! public option describ$ 9 
subsection 7a7 %all-- 7#a7 provide !    
ess5tial heal? b5efits package 7z def9$ 
9 section #acjb7;a772  7#b7 comply ) !  
requirem5ts ( ?is title & ! am5dm5ts    
made by ?is title1 to ! ext5t           
practicable1 applicable to a heal? plan 
(f]$ ?r\gh an ,ex*ange2 &  7#c7 consi/ (
 a plan 9 ! silv] level ( cov]age 7z    
describ$ 9 section #acjb7;d774  7c7     
,enrollm5t & cov]age p]iods ,! ,secret>y
 %all e/abli% enrollm5t & cov]age p]iods
 = individuals :o enroll 9 ! public     
option4 ,su* p]iods %all be e/abli%$1 to

 ! ext5t practicable1 9 coord9ation ) ! 
enrollm5t & cov]age p]iods = o!r plans  
(f]$ ?r\gh an ,ex*ange4  7d7 ,premiums  
7#a7 ,mon?ly premium ,! ,secret>y %all  
det]m9e a mon?ly premium = individuals  
enroll$ 9 ! public option4 ,su* mon?ly  
premium %all be equal to #a_/ab ( !     
annual premium comput$ "u p>agraph      
7#b77;,b74  7#b7 ,annual premium  7,a7  
,e/imation ,! ,secret>y %all e/imate !  
av]age1 annual p] capita am\nt = b5efits
 & adm9i/rative exp5ses payable "u ?is  
section = individuals 9 ea* age b&      
specifi$ 9 subp>agraph 7,c7 enroll$ 9 ! 
public option4  7,b7 ,computation ,!    
annual premium "u ?is subsection = mon?s
 9 a ye> is equal to ! av]age1 annual p]
 capita am\nt e/imat$ "u p>agraph 7#a7 =
 ! ye> = ea* age b& specifi$ 9          
subparagraph 7,c71 geographically adju/$
 by rat+ area4  7,c7 ,age b&s ,! age b&s
 specifi$ 9 ?is subp>agraph are ! age   
b&s def9$ by ! ,secret>y pursuant to    
section #bgja7;a77#c7 ( ! ,public ,heal?
 ,s]vice ,act 7#db ,u4,s4,c4            

#cjj;gg7a77#c774  7#c7 ,v>iation 9      
premium rates ,! premium rate *>g$ = !  
public option may n v>y except z provid$
 "u section #bgja ( su* ,act 7#db       
,u4,s4,c4 #cjj;gg74  7e7 ,paym5t (      
premiums  7#a7 ,9 g5]al ,premiums =     
enrollm5t 9 ! public option %all be paid
 to ! ,secret>y at su* times1 & 9 su*   
mann]1 z ! ,secret>y det]m9es           
appropriate4  7#b7 ,deposit ,am\nts     
collect$ by ! ,secret>y "u ?is section  
%all be deposit$ 9 ! acc\nt e/abli%$ "u 
subsection 7f74  7f7 ,acc\nt  7#a7      
,e/abli%m5t ,!re is e/abli%$ 9 !        
,treasury ( ! ,unit$ ,/ates an acc\nt = 
! receipts & disbursem5ts attributable  
to ! op]ation ( ! public option4  7#b7  
,prohibition ( ,/ate imposition ( taxes 
,section #ahed7;g7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciew-#bd7;g77    
%all apply to receipts & disbursem5ts   
describ$ 9 p>agraph 7#a7 9 ! same mann] 
z su* section applies to paym5ts or     
premiums describ$ 9 su* section4  7g7   
,heal? c>e provid] paym5t rates = items 

& s]vices  7#a7 ,9 g5]al  7,a7 ,rates   
negotiat$ by ! ,secret>y ,subject to    
subp>agraph 7,b71 ! ,secret>y %all1     
?r\gh a negotiat$ agreem5t ) heal? c>e  
provid]s1 e/abli% rates = reimburs+     
heal? c>e provid]s = provid+ ! b5efits  
cov]$ by ! public option4  7,b7 ,m$ic>e 
reimbursem5t rates ,if ! ,secret>y &    
heal? c>e provid]s are unable to rea* a 
negotiat$ agreem5t on a reimbursem5t    
rate1 ! ,secret>y %all reimburse        
provid]s at rates det]m9$ = equival5t   
items & s]vices "u ! orig9al ,m$ic>e    
fee-=-s]vice program "u p>ts ,a & ,b (  
title ,,xviii ( ! ,social ,security     
,act4  7,c7 ,= new s]vices ,! ,secret>y 
%all modify reimbursem5t rates describ$ 
9 subp>agraph 7,b7 9 ord] to accommodate
 paym5ts = s]vices t are n o!rwise cov]$
 "u ! orig9al m$ic>e fee-=-s]vice       
program4  7#b7 ,prescription drugs ,any 
paym5t rate "u ?is subsection = a       
prescription drug %all be at a rate     
negotiat$ by ! ,secret>y4 ,if !         
,secret>y is unable to rea* a negotiat$ 

agreem5t on su* a reimbursem5t rate1 !  
,secret>y %all use rates det]m9$ =      
equival5t drugs paid = "u ! orig9al     
m$ic>e fee-=-s]vice program4 ,!         
,secret>y %all modify su* rates 9 ord]  
to accommodate paym5ts = drugs t are n  
o!rwise cov]$ "u ! orig9al m$ic>e       
fee-=-s]vice program4  7h7 ,heal? c>e   
provid] p>ticipation  7#a7 ,provid]     
p>ticipation  7,a7 ,9 g5]al ,! ,secret>y
 %all e/abli% conditions ( p>ticipation 
= heal? c>e provid]s "u ! public option4
  7,b7 ,lic5sure or c]tification ,!     
,secret>y %all n all[ a heal? c>e       
provid] to p>ticipate 9 ! public option 
unless su* provid] is appropriately     
lic5s$ or c]tifi$ "u ,/ate law4  7#b7   
,e/abli%m5t ( a provid] network  7,a7   
,m$ic>e & ,m$icaid p>ticipat+ provid]s  
,a heal? c>e provid] t is a p>ticipat+  
provid] ( s]vices or suppli] "u !       
,m$ic>e program "u title ,,xviii ( !    
,social ,security ,act or "u a ,/ate    
,m$icaid plan "u title ,,xix ( su* ,act 
is a p>ticipat+ provid] 9 ! public      

option unless ! heal? c>e provid] opts  
out ( p>ticipat+ 9 ! public option ?r\gh
 a process e/abli%$ by ! ,secret>y4     
7,b7 ,additional provid]s ,! ,secret>y  
%all e/abli% a process to all[ heal? c>e
 provid]s n describ$ 9 subp>agraph 7,a7 
to become p>ticipat+ provid]s 9 ! public
 option4  7i7 ,adm9i/rative contract+   
7#a7 ,au?orities ,! ,secret>y may ent]  
into contracts = ! purpose ( p]=m+      
adm9i/rative functions 7includ+         
functions describ$ 9 subsection 7a77#d7 
( section #ahgd;,a ( ! ,social ,security
 ,act7 ) respect to ! public option 9 ! 
same mann] z ! ,secret>y may ent] into  
contracts "u subsection 7a77#a7 ( su*   
section4 ,! ,secret>y %all h ! same     
au?ority ) respect to ! public option z 
! ,secret>y has "u su* subsection       
7a77#a7 & subsection 7b7 ( section      
#ahgd;,a ( ! ,social ,security ,act )   
respect to title ,,xviii ( su* ,act4    
7#b7 ,transf] ( insurance risk ,any     
contract "u ?is p>agraph %all n involve 
! transf] ( insurance risk f ! ,secret>y

 to ! entity ent]+ into su* contract ) !
 ,secret>y4  4  7b7 ,con=m+ am5dm5ts    
7#a7 ,treatm5t z a qualifi$ heal? plan  
,section #acja7;a77#b7 ( ! ,pati5t      
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjba7;a77#b77 is am5d$--    
7,a7 9 ! p>agraph head+1 by ins]t+ 81   
,,! ,,public ,,heal? ,,insurance        
,,option10 be=e 8&02 &  7,b7 by ins]t+  
8! public heal? insurance option "u     
section #acad10 be=e 8& a multi-,/ate   
plan04  7#b7 ,/ate insurance regulation 
,section #acbd7;a7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjdd7;a77 is am5d$ by ins]t+
 8! public heal? insurance option "u    
section #bgie ( ! ,public ,heal? ,s]vice
 ,act10 be=e 8or a multi-,/ate qualifi$ 
heal? plan04