,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #gjg  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,janu>y #bg1          
#bjag,mrs4 ,blackburn introduc$ ! foll[+
 bill2 :i* 0 ref]r$ to ! ,committee on  
,ways & ,means1 & 9 addition to !       
,committee on ,en]gy & ,comm]ce1 = a    
p]iod to be subsequ5tly det]m9$ by !    
,speak]1 9 ea* case = consid]ation ( su*
 provisions z fall )9 ! jurisdiction ( !
 committee conc]n$  ,a ,,bill  ,to am5d 
! ,social ,security ,act to improve     
*oices available to ,m$ic>e eligible    
s5iors by p]mitt+ !m to elect 7in/ead ( 
regul> ,m$ic>e b5efits7 to receive a    
v\*] = a heal? sav+s acc\nt1 = premiums 
= a high d$uctible heal? insurance plan1
 or bo? & by susp5d+ ,m$ic>e late       
enrollm5t p5alties betwe5 ages #fe &    
#gj4  #a4 ,%ort title ,?is ,act may be  
cit$ z ! ,heal? ,c>e ,*oices = ,s5iors  
,act4  #b4 ,f9d+s ,congress f9ds !      
foll[+3  7#a7 ,! ,social ,security      
,adm9i/ration's ,program ,op]ations     
,manual ,sy/em section ,,hi #jjhja4jjb1 

titl$ ,waiv] ( ,hospital ,insurance     
,entitlem5t by ,mon?ly ,b5efici>y1      
provides t an individual :o does n sign 
up = "p ,a ( ! ,m$ic>e program :5 !     
individual signs up = social security   
b5efits w lose su* b5efits1 reg>dless ( 
! desire ( ! individual to n p>ticipate 
9 ! ,m$ic>e program because ( religi\s  
or philosophical reasons or a pref]5ce  
to h private heal? insurance4  7#b7 ,z  
"p ( ! ,m$ic>e ,prescription ,drug1     
,improvem5t1 & ,mod]nization ,act (     
#bjjc 7,public ,law #ajh-agc71 ,congress
 increas$ heal? insurance options by    
au?oriz+ heal? sav+s acc\nts into :i*   
individuals may make annual             
contributions ( n m ?an #b1fej &        
families may make su* contributions ( n 
m ?an #e1bej t are all[able z d$uctions 
= income tax purposes4 ,s5iors are n    
all[$ to d$uct contributions to _! heal?
 sav+s acc\nt aft] ! date ( ! entitlem5t
 ( su* s5iors to ,m$ic>e b5efits4  7#c7 
,section #ahjb7;b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acie;a7b771 add$  

by section #dejg ( ! ,balanc$ ,budget   
,act ( #aiig1 /ates t a ,m$ic>e         
b5efici>y may only ent] into a private  
contract ) a physician = an item or     
s]vice if no claim = paym5t "u title    
,,xviii ( su* ,act w be submitt$4 ,9 !  
case ( su* contract1 ! physician mu/    
sign an affidavit t ackn[l$ges su*      
contract & t provides t ! physician w n 
submit a claim1 & w =go reimbursem5t1 "u
 su* title = an item or s]vice provid$  
to any ,m$ic>e b5efici>y = a p]iod ( two
 ye>s4  #c4 ,au?ority to elect v\*]     
program in/ead ( ,m$ic>e "p ,a          
entitlem5t  7a7 ,9 g5]al ,section #bbf (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #dbf7 is am5d$ by add+ at ! end !      
foll[+ new subsections3  7k7 ,waiv] (   
entitlem5t & election ( v\*] program    
7#a7 ,9 g5]al ,not)/&+ ! previ\s        
provisions ( ?is section1 ! ,secret>y   
%all e/abli% a proc$ure "u :i* an       
individual o!rwise entitl$ "u subsection
 7a7 to b5efits "u "p ,a ( title ,,xviii
 may waive su* entitlem5t & be          

automatically enroll$ 9 ! ,m$ic>e       
,alt]native ,v\*] ,program e/abli%$ "u  
subsection 7l7 if--  7,a7 at ! "t su*   
waiv] is made ! individual-- 7i7 has a  
heal? sav+s acc\nt describ$ 9 subsection
 7d7 ( section #bbc ( ! ,int]nal ,rev5ue
 ,code ( #aihf 7#bf ,u4,s4,c4 #bbc72 &  
7ii7 is enroll$ "u a high d$uctible     
heal? plan1 z def9$ 9 subsection 7c77#a7
 ( su* section2 &  7,b7 ! individual    
makes su* waiv] dur+ ! initial enrollm5t
 p]iod describ$ 9 section #ahcg7;d74    
7#b7 ,treatm5t "u ! ,int]nal ,rev5ue    
,code ( #aihf ,an individual :o waives  
entitlem5t "u p>agraph 7#a7 %all n be   
treat$ z entitl$ to b5efits "u title    
,,xviii = purposes ( section            
#bbc7;b77#g7 ( ! ,int]nal ,rev5ue ,code 
( #aihf4  7#c7 ,ineligibility = "p ,b or
 ,d b5efits ,an individual %all n be    
eligible = b5efits "u "p ,b or ,d (     
title ,,xviii dur+ ! p]iod = :i* !      
individual waives entitlem5t "u "p ,a ( 
su* title "u p>agraph 7#a74  7#d7       
,t]m9ation ( waiv] & re5rollm5t "u      

,m$ic>e program ,! ,secret>y %all       
e/abli% a proc$ure "u :i* an individual 
:o waives entitlem5t "u p>agraph 7#a7   
may t]m9ate su* waiv] dur+ an annual    
p]iod t %all be ! same z ! annual g5]al 
enrollm5t p]iod describ$ 9 section      
#ahcg7;e74 ,= purposes ( apply+ p>ts ,b 
& ,d ( title ,,xviii1 su* individual    
%all be treat$ z if ! individual 7      
entitl$ to b5efits "u "p ,a ( su* title 
z ( ! date su* individual t]m9ates !    
waiv] "u ?is p>agraph4 ,an individual :o
 has t]m9at$ su* a waiv] may n          
subsequ5tly make su* a waiv]4  7l7      
,m$ic>e ,alt]native ,v\*] ,program  7#a7
 ,e/abli%m5t ( program ,! ,secret>y %all
 e/abli% a program to be kn[n z !       
,m$ic>e ,alt]native ,v\*] ,program 79   
?is subsection ref]r$ to z ! v\*]       
program7 consi/5t ) ?is subsection4     
7#b7 ,automatic enrollm5t ,an individual
 :o waives entitlem5t "u subsection     
7k77#a7 %all be enroll$ 9 ! v\*] program
 = ! p]iod dur+ :i* su* waiv] is 9      
effect4  7#c7 ,am\nt ( v\*]  7,a7 ,am\nt

 bas$ on age cohort  7i7 ,9 g5]al       
,subject to clause 7ii71 = ea* mon? t an
 individual )9 an age cohort is enroll$ 
9 ! v\*] program1 ! ,secret>y %all      
provide a v\*] to su* individual 9 an   
am\nt t is equal to ! mon?ly actu>ial   
rate = t mon? comput$ "u section        
#ahah7;d77#a7 multipli$ by ! age cohort 
adju/m5t factor = su* age cohort "u     
subp>agraph 7,b74  7ii7 ,mon?ly limit ,!
 am\nt ( a v\*] provid$ to an individual
 = a mon? may n exce$ #bjj4  7,b7 ,age  
cohort adju/m5t factor ,= ea* age cohort
 ! ,secret>y %all det]m9e an age cohort 
adju/m5t factor equal to ! ratio (--    
7i7 ! mon?ly actu>ial rate describ$ 9   
section #ahah7;d77#a7 z det]m9$ by !    
,secret>y = individuals 9 su* age       
cohort1 to  7ii7 ! mon?ly actu>ial rate 
describ$ 9 su* section4  7,c7 ,age      
cohort def9$ ,= purposes ( ?is p>agraph1
 an age cohort means a gr\p (           
individuals ^: age falls )9 a span (    
five consecutive ye>s1 consi/5t ) !     
foll[+3  7i7 ,! fir/ su* span beg9s at  

age #fe4  7ii7 ,o!r spans foll[         
consecutively4  7#d7 ,p]missible use (  
v\*] ,a v\*] "u p>agraph 7#c7 may be us$
 only = ! foll[+ purposes3 7,a7 ,z a    
contribution into a heal? sav+s acc\nt  
e/abli%$ by su* individual1 z describ$ 9
 subsection 7k77#a77;,a74  7,b7 ,=      
paym5t ( premiums = enrollm5t ( su*     
individual "u a high d$uctible heal?    
plan describ$ 9 su* subsection4  7#e7   
,effect ( subsequ5t t]m9ation ( waiv]   
,if an individual t]m9ates a waiv] "u   
subsection 7k77#d71 ! enrollm5t ( su*   
individual 9 ! v\*] program %all be     
t]m9at$ on ! date on :i* ! t]m9ation    
becomes effective4  4  7b7 ,am5dm5t (   
,int]nal ,rev5ue ,code ( #aihf ,p>agraph
 7#g7 ( section #bbc7;b7 ( ! ,int]nal   
,rev5ue ,code ( #aihf 7relat+ to ,m$ic>e
 eligible individuals7 is am5d$ to read 
z foll[s3  7#g7 ,m$ic>e eligible        
individuals  7,a7 ,9 g5]al ,! limitation
 "u ?is subsection = any mon? ) respect 
to an individual %all be z]o = any mon? 
su* individual is entitl$ to b5efits "u 

title ,,xviii ( ! ,social ,security     
,act4  7,b7 ,m$ic>e alt]native v\*]     
program ,9 ! case ( an individual :o is 
enroll$ 9 ! ,m$ic>e ,alt]native ,v\*]   
,program "u section #bbf7l7 ( ! ,social 
,security ,act1 ! applicable limitation 
"u subp>agraphs 7,a7 & 7,b7 ( p>agraph  
7#b7 %all be increas$ by ! am\nt ( !    
v\*] describ$ 9 p>agraph 7#c7 ( su*     
section :i* is contribut$ to a heal?    
sav+s acc\nt ( su* individual4  4  7c7  
,effective date  7#a7 ,9 g5]al ,!       
am5dm5t made by subsection 7a7 %all take
 effect on ! date t is six mon?s aft] ! 
date ( ! enactm5t ( ?is ,act & %all     
apply to an individual :o becomes       
entitl$ to b5efits "u "p ,a ( title     
,,xviii ( ! ,social ,security ,act on or
 aft] su* date ( ! enactm5t4  7#b7      
,am5dm5t ( ,int]nal ,rev5ue ,code (     
#aihf ,! am5dm5t made by subsection 7b7 
%all apply to mon?s end+ aft] ! date    
ref]r$ to 9 p>agraph 7#a71 9 taxable    
ye>s end+ aft] su* date4  #d4 ,susp5sion
 ( ,m$ic>e late enrollm5t p5alties      

betwe5 ages #fe & #gj  7a7 ,"p ,b ,!    
second s5t5ce ( section #ahci7;b7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acier7b77 is am5d$ by ins]t+ be=e !    
p]iod ! foll[+3 & !re %all n be tak5    
into acc\nt 7= individuals n entitl$ to 
b5efits "u section #bbf;,a7 any mon?    
dur+ any "p ( :i* ! individual atta9$   
age #fe & has n atta9$ age #gj4  7b7 ,"p
 ,d  7#a7 ,9 g5]al ,section             
#ahfj;,d-#ac7;b77#g77;,a7 ( su* ,act    
7#db ,u4,s4,c4 #aciew-#aac7;b77#g77;,a77
 is am5d$ by add+ at ! end ! foll[+     
s5t5ce3 ,= purposes ( ! prec$+ s5t5ce1 9
 ! case ( an individual n entitl$ to    
b5efits "u "p ,a "u section #bbf;,a1 a  
cont9u\s p]iod ( eligibility %all n     
include any mon? dur+ any "p ( :i* !    
individual atta9$ age #fe & has n atta9$
 age #gj44  7#b7 ,con=m+ am5dm5t        
,section #ahfj;,d-#a7;b77#f77;,a7 ( su* 
,act 7#db ,u4,s4,c4                     
#aciew-#aja7;b77#f77;,a77 is am5d$ by   
ins]t+ aft] p>agraph 7#b7 ! foll[+3 1 b 
exclud+ ! p]iod betwe5 #fe & #gj ye>s ( 

age4  7c7 ,effective date ,! am5dm5ts   
made by ?is section %all apply to       
individuals :o atta9 #fe ye>s ( age 9 a 
mon? aft] ! mon? 9 :i* ?is ,act is      
enact$4