,,ii  #aae? ,,congress  #a/ ,session    
,s4 #agdb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,augu/ #c1 #bjag,ms4   
,/ab5[ 7= h]self1 ,mr4 ,br[n1 ,ms4      
,baldw91 ,mr4 ,:iteh\se1 ,mr4 ,leahy1   
,mr4 ,m]kley1 ,mr4 ,re$1 ,mr4 ,frank51 &
 ,mr4 ,book]7 introduc$ ! foll[+ bill2  
:i* 0 read twice & ref]r$ to !          
,committee on ,f9ance  ,a ,,bill  ,to   
am5d title ,,xviii ( ! ,social ,security
 ,act to provide = an option = any      
citiz5 or p]man5t resid5t ( ! ,unit$    
,/ates age #ee to #fd to buy into       
,m$ic>e4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,m$ic>e at #ee ,act4  #b4   
,m$ic>e buy-9 option = individuals #ee  
to #fd ye>s ( age  7a7 ,9 g5]al ,title  
,,xviii ( ! ,social ,security ,act 7#db 
,u4,s4,c4 #acie;c et seq47 is am5d$ by  
add+ at ! end ! foll[+ new section3     
#ahii;,c4 ,m$ic>e buy-9 option =        
individuals #ee to #fd ye>s ( age  7a7  
,option  7#a7 ,9 g5]al ,e individual :o 
meets ! requirem5ts describ$ 9 p>agraph 
7#c7 %all be eligible to enroll "u ?is  

section4  7#b7 ,"p ,a1 ,b1 & ,d b5efits 
,an individual enroll$ "u ?is section is
 entitl$ to ! same b5efits 7& %all      
receive ! same protections7 "u ?is title
 z an individual :o is entitl$ to       
b5efits "u "p ,a & enroll$ "u p>ts ,b & 
,d1 includ+ ! ability to enroll 9 a     
,m$ic>e ,advantage plan t provides      
qualifi$ prescription drug cov]age 7an  
,,ma-,,pd plan74  7#c7 ,requirem5ts =   
eligibility ,! requirem5ts describ$ 9   
?is p>agraph are ! foll[+3 7,a7 ,!      
individual is a resid5t ( ! ,unit$      
,/ates4  7,b7 ,! individual is-- 7i7 a  
citiz5 or national ( ! ,unit$ ,/ates2 or
  7ii7 an ali5 lawfully admitt$ =       
p]man5t resid5ce4  7,c7 ,! individual is
 n o!rwise entitl$ to b5efits "u "p ,a  
or eligible to enroll "u "p ,a or "p ,b4
  7,d7 ,! individual has atta9$ #ee ye>s
 ( age b has n atta9$ #fe ye>s ( age4   
7b7 ,enrollm5t2 cov]age ,! ,secret>y    
%all e/abli% enrollm5t p]iods & cov]age 
"u ?is section consi/5t ) ! pr9ciples = 
e/abli%m5t ( enrollm5t p]iods & cov]age 

= individuals "u o!r provisions ( ?is   
title4 ,! ,secret>y %all e/abli% su*    
p]iods s t cov]age "u ?is section %all  
fir/ beg9 on ,janu>y #a1 #bjai4  7c7    
,premium  7#a7 ,am\nt ( mon?ly premiums 
,! ,secret>y %all1 dur+ ,septemb] ( ea* 
ye> 7beg9n+ ) #bjah71 det]m9e a mon?ly  
premium = all individuals enroll$ "u ?is
 section4 ,su* mon?ly premium %all be   
equal to #a_/ab ( ! annual premium      
comput$ "u p>agraph 7#b77;,b71 :i* %all 
apply ) respect to cov]age provid$ "u   
?is section = any mon? 9 ! succe$+ ye>4 
7#b7 ,annual premium  7,a7 ,comb9$ p]   
capita av]age = all ,m$ic>e b5efits ,!  
,secret>y %all e/imate ! av]age1 annual 
p] capita am\nt = b5efits & adm9i/rative
 exp5ses t w be payable "u p>ts ,a1 ,b1 
& ,d 7includ+1 z applicable1 "u "p ,c7 9
 ! ye> = all individuals enroll$ "u ?is 
section4  7,b7 ,annual premium ,! annual
 premium "u ?is subsection = mon?s 9 a  
ye> is equal to ! av]age1 annual p]     
capita am\nt e/imat$ "u subp>agraph 7,a7
 = ! ye>4  7#c7 ,increas$ premium =     

c]ta9 "p ,c & ,d plans ,no?+ 9 ?is      
section %all preclude an individual f   
*oos+ a ,m$ic>e ,advantage plan or a    
prescription drug plan :i* requires !   
individual to pay an additional am\nt   
7because ( supplem5tal b5efits or       
because x is a m exp5sive plan74 ,9 su* 
case ! individual w\ld be responsible = 
! increas$ mon?ly premium4  7d7 ,paym5t 
( premiums  7#a7 ,9 g5]al ,premiums =   
enrollm5t "u ?is section %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 ! ,f$]al ,hospital   
,insurance ,tru/ ,fund & ! ,f$]al       
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund 7includ+ ! ,m$ic>e ,prescription  
,drug ,acc\nt )9 su* ,tru/ ,fund7 9 su* 
proportion z ! ,secret>y det]m9es       
appropriate4  7e7 ,n eligible = ,m$ic>e 
co/-,%>+ assi/ance ,an individual       
enroll$ "u ?is section %all n be treat$ 
z enroll$ "u any "p ( ?is title =       

purposes ( obta9+ m$ical assi/ance =    
,m$ic>e co/-%>+ or o!rwise "u title     
,,xix4  7f7 ,treatm5t 9 relation to !   
,af=dable ,c>e ,act  7#a7 ,satisfaction 
( individual m&ate ,= purposes ( apply+ 
section #ejjj;,a ( ! ,int]nal ,rev5ue   
,code ( #aihf1 ! cov]age provid$ "u ?is 
section con/itutes m9imum ess5tial      
cov]age "u subsection 7f77#a77;,a77i7 ( 
su* section #ejjj;,a4  7#b7 ,eligibility
 = premium assi/ance ,cov]age provid$ "u
 ?is section--  7,a7 %all be treat$ z   
cov]age "u a qualifi$ heal? plan 9 !    
individual m>ket enroll$ 9 ?r\gh !      
,ex*ange :]e ! individual resides = all 
purposes ( section #cf;,b ( ! ,int]nal  
,rev5ue ,code ( #aihf o!r ?an subsection
 7c77#b77;,b7 !re(2 &  7,b7 %all n be   
treat$ z eligibility = o!r m9imum       
ess5tial cov]age = purposes ( subsection
 7c77#b77;,b7 ( su* section #cf;,b4  ,! 
,secret>y %all det]m9e ! applicable     
second l[e/ co/ silv] plan :i* %all     
apply to cov]age "u ?is section =       
purposes ( section #cf;,b ( su* ,code4  

7#c7 ,eligibility = co/-%>+ subsidies ,=
 purposes ( apply+ section #adjb ( !    
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjga7--  7,a7     
cov]age provid$ "u ?is section %all be  
treat$ z cov]age "u a qualifi$ heal?    
plan 9 ! silv] level ( cov]age 9 !      
individual m>ket (f]$ ?r\gh an ,ex*ange2
 &  7,b7 ! ,secret>y %all be treat$ z ! 
issu] ( su* plan4  7g7 ,gu>ante$ issue (
 ,m$igap policies ^u fir/ enrollm5t &   
ea* subsequ5t enrollm5t ,9 ! case ( an  
individual :o enrolls "u ?is section    
7includ+ an individual :o 0 previ\sly   
enroll$ "u ?is section71 p>agraphs      
7#b77;,a71 7#b77;,d71 7#c77;,b77ii71 &  
7#c77;,b77vi7 ( section #ahhb7s7--  7#a7
 %all be appli$ by sub/itut+ #ee = #fe2 
7#b7 if ! individual 0 enroll$ "u ?is   
section & subsequ5tly dis5rolls1 %all   
apply ea* "t ! individual subsequ5tly   
re5rolls "u ?is section z if !          
individual _h atta9$ #ee ye>s ( age on !
 date ( su* re5rollm5t 7& z if !        
individual _h nev] previ\sly enroll$ 9 a

 ,m$ic>e supplem5tal policy72 &  7#c7   
%all be appli$ z if ?is section _h n be5
 enact$ 7& z if ! individual _h nev]    
previ\sly enroll$ 9 a ,m$ic>e           
supplem5tal policy7 :5 ! individual     
atta9s #fe ye>s ( age4  7h7 ,no effect  
on b5efits = individuals o!rwise        
eligible or on ,tru/ funds ,! ,secret>y 
%all implem5t ! provisions ( ?is section
 9 su* a mann] to ensure t su*          
provisions--  7#a7 h no effect on !     
b5efits "u ?is title = individuals :o   
are entitl$ to1 or enroll$ =1 su*       
b5efits o!r ?an ?r\gh ?is section2 &    
7#b7 h no negative impact on ! ,f$]al   
,hospital ,insurance ,tru/ ,fund or !   
,f$]al ,supplem5t>y ,m$ical ,insurance  
,tru/ ,fund 7includ+ ! ,m$ic>e          
,prescription ,drug ,acc\nt )9 su* ,tru/
 ,fund74  7i7 ,consultation ,9          
promulgat+ regulations to implem5t ?is  
section1 ! ,secret>y %all consult )     
int]e/$ p>ties1 includ+ gr\ps repres5t+ 
b5efici>ies1 heal? c>e provid]s1        
employ]s1 & insurance companies4  4