,,ii  #aaeth ,,congress  #ast ,session  
,s4 #eed  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,march #g1 #bjag,mr4
 ,paul 7for himself and ,mr4 ,lee7      
introduced the following bill2 which was
 read twice and referred to the         
,committee on ,finance  ,a ,,bill  ,to  
provide for reconciliation pursuant to  
section #bjjb of the concurrent         
resolution on the budget for fiscal year
 #bjag4  ,i ,health1 ,education1 ,labor1
 and ,pensions  #aja4 ,the prevention   
and public health fund  7a7 ,in general 
,subsection 7b7 of section #djjb of the 
,patient ,protection and ,affordable    
,care ,act 7#db ,u4,s4,c4 #cjju-#aa7 is 
amended by striking paragraphs 7#c7     
through 7#h74  7b7 ,rescission of       
unobligated funds ,of the funds made    
available by such section #djjb1 the    
unobligated balance is rescinded4  #ajb4
 ,community health center program       
,effective as if included in the        
enactment of the ,medicare ,access and  
,,chip ,reauthorization ,act of #bjae   

7,public ,law #aad-aj1 #abi2 ,stat4     
#hg71 paragraph 7#a7 of section #bba7;a7
 of such ,act is amended by inserting 1 
an additional #bce1jjj1jjj for fiscal   
year #bjag1 and #bce1jjj1jjj for fiscal 
year #bjah after through #bjag4  #ajc4  
,reinsurance1 risk corridor1 and risk   
adjustment programs  7a7 ,transitional  
reinsurance program for individual      
market ,section #acda of the ,patient   
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #ahjfa7 is amended by    
adding at the end the following3  7e7   
,no force and effect ,effective ,january
 #a1 #bjah1 the ,secretary shall not    
make payments under this section4  4    
#ajd4 ,support for ,state response to   
substance abuse public health crisis and
 urgent mental health needs  7a7 ,in    
general ,there are authorized to be     
appropriated1 and are appropriated1 out 
of monies in the ,treasury not otherwise
 obligated1 #gej1jjj1jjj for each of    
fiscal years #bjah and #bjai1 to the    
,secretary of ,health and ,human        

,services 7referred to in this section  
as the ,secretary7 to award grants to   
,states to address the substance abuse  
public health crisis or to respond to   
urgent mental health needs within the   
,state4 ,in awarding grants under this  
section1 the ,secretary may give        
preference to ,states with an incidence 
or prevalence of substance use disorders
 that is substantial relative to other  
,states or to ,states that identify     
mental health needs within their        
communities that are urgent relative to 
such needs of other ,states4 ,funds     
appropriated under this subsection shall
 remain available until expended4  7b7  
,use of funds ,grants awarded to a      
,state under subsection 7a7 shall be    
used for one or more of the following   
public health-related activities3  7#a7 
,improving ,state prescription drug     
monitoring programs4  7#b7 ,implementing
 prevention activities1 and evaluating  
such activities to identify effective   
strategies to prevent substance abuse4  

7#c7 ,training for health care          
practitioners1 such as best practices   
for prescribing opioids1 pain           
management1 recognizing potential cases 
of substance abuse1 referral of patients
 to treatment programs1 and overdose    
prevention4  7#d7 ,supporting access to 
health care services provided by        
federally certified opioid treatment    
programs or other appropriate health    
care providers to treat substance use   
disorders or mental health needs4  7#e7 
,other public health-related activities1
 as the ,state determines appropriate1  
related to addressing the substance     
abuse public health crisis or responding
 to urgent mental health needs within   
the ,state4  ,,ii ,finance  #bja4       
,recapture excess advance payments of   
premium tax credits ,subparagraph 7,b7  
of section #cf;,b7f77#b7 of the         
,internal ,revenue ,code of #aihf is    
amended by adding at the end the        
following new clause3  7iii7            
,nonapplicability of limitation ,this   

subparagraph shall not apply to taxable 
years ending after ,december #ca1 #bjag1
 and before ,january #a1 #bjbj4  4      
#bjb4 ,premium tax credit and           
cost-,sharing subsidies  7a7 ,repeal of 
premium tax credit ,subpart ,c of part  
,,iv of subchapter ,a of chapter #a of  
the ,internal ,revenue ,code of #aihf is
 amended by striking section #cf;,b4    
7b7 ,repeal of cost-,sharing subsidy    
,section #adjb of the ,patient          
,protection and ,affordable ,care ,act  
is repealed4  7c7 ,repeal of eligibility
 determinations ,the following sections 
of the ,patient ,protection and         
,affordable ,care ,act are repealed3    
7#a7 ,section #adaa 7other than         
subsection 7i71 the last sentence of    
subsection 7e77#d77;,a77ii71 and such   
provisions of such section solely to the
 extent related to the application of   
the last sentence of subsection         
7e77#d77;,a77ii774  7#b7 ,section #adab4
  7d7 ,protecting ,americans by repeal  
of disclosure authority ,to carry out   

eligibility requirements for certain    
programs  7#a7 ,in general ,paragraph   
7#ba7 of section #fajc7l7 of the        
,internal ,revenue ,code of #aihf is    
amended by adding at the end the        
following new subparagraph3  7,d7       
,termination ,no disclosure may be made 
under this paragraph after ,december    
#ca1 #bjai4  4  7e7 ,effective dates    
7#a7 ,premium tax credit ,the amendment 
made by subsection 7a7 shall apply to   
taxable years beginning after ,december 
#ca1 #bjai4  7#b7 ,cost                 
sharing-subsidies and eligibility       
determinations ,the repeals in          
subsection 7b7 and 7c7 shall take effect
 on ,december #ca1 #bjai4  7#c7         
,protecting ,americans by rescinding    
disclosure authority ,the amendments    
made by subsection 7d7 shall take effect
 on ,december #ca1 #bjai4  #bjc4 ,small 
business tax credit  7a7 ,in general    
,section #de,r of the ,internal ,revenue
 ,code of #aihf is amended by adding at 
the end the following new subsection3   

7j7 ,shall not apply ,this section shall
 not apply with respect to amounts paid 
or incurred in taxable years beginning  
after ,december #ca1 #bjai4  4  7b7     
,effective date ,the amendment made by  
this section shall apply to amounts paid
 or incurred in taxable years beginning 
after ,december #ca1 #bjai4  #bjd4      
,individual mandate  7a7 ,in general    
,section #ejjj;,a7c7 of the ,internal   
,revenue ,code of #aihf is amended--    
7#a7 in paragraph 7#b77;,b7--  7,a7 by  
striking after #bjae in clause 7iii7 and
 inserting in #bjaf1 and  7,b7 by adding
 at the end the following new clause3   
7iv7 ,zero percent for taxable years    
beginning after #bjaf4  1 and  7#b7 in  
paragraph 7#c7--  7,a7 by striking #fie 
in subparagraph 7,a7 and inserting #j1  
7,b7 by striking and #cbe for #bjad in  
subparagraph 7,b7 and inserting 1 #cbe1 
for #bjad1 and #fie for #bjaf1 and  7,c7
 by striking subparagraph 7,d74  7b7    
,effective date ,the amendments made by 
this section shall apply to months      

beginning after ,december #ca1 #bjaf4   
#bje4 ,employer mandate  7a7 ,in general
  7#a7 ,paragraph 7#a7 of section       
#dihj;,h7c7 of the ,internal ,revenue   
,code of #aihf is amended by inserting  
7#j in the case of months beginning     
after ,december #ca1 #bjaf7 after       
#b1jjj4  7#b7 ,paragraph 7#a7 of section
 #dihj;,h7b7 of the ,internal ,revenue  
,code of #aihf is amended by inserting  
7#j in the case of months beginning     
after ,december #ca1 #bjaf7 after       
#c1jjj4  7b7 ,effective date ,the       
amendments made by this section shall   
apply to months beginning after         
,december #ca1 #bjaf4  #bjf4 ,federal   
payments to ,states  7a7 ,in general    
,notwithstanding section #ejd7;a71      
#aijb7;a77#bc71 #aijc7;a71 #bjjb1       
#bjje7;a77#d71 #bajb7;a77#g71 or        
#baje7;a77#a7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #gjd7;a71           
#acif;a7a77#bc71 #acif;b7a71 #acig;a1   
#acig;d7a77#d71 #acig;bb7a77#g71        
#acig;ee7a77#a771 or the terms of any   

,medicaid waiver in effect on the date  
of enactment of this ,act that is       
approved under section #aaae or #aiae of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acae1 #acifn71 for the       
#a-year period beginning on the date of 
enactment of this ,act1 no ,federal     
funds provided from a program referred  
to in this subsection that is considered
 direct spending for any year may be    
made available to a ,state for payments 
to a prohibited entity1 whether made    
directly to the prohibited entity or    
through a managed care organization     
under contract with the ,state4  7b7    
,definitions ,in this section3 7#a7     
,prohibited entity ,the term prohibited 
entity means an entity1 including its   
affiliates1 subsidiaries1 successors1   
and clinics--  7,a7 that1 as of the date
 of enactment of this ,act-- 7i7 is an  
organization described in section       
#eja7;c77#c7 of the ,internal ,revenue  
,code of #aihf and exempt from tax under
 section #eja7;a7 of such ,code2  7ii7  

is an essential community provider      
described in section #aef4bce of title  
#de1 ,code of ,federal ,regulations 7as 
in effect on the date of enactment of   
this ,act71 that is primarily engaged in
 family planning services1 reproductive 
health1 and related medical care2 and   
7iii7 provides for abortions1 other than
 an abortion-- 7,i7 if the pregnancy is 
the result of an act of rape or incest2 
or  7,,ii7 in the case where a woman    
suffers from a physical disorder1       
physical injury1 or physical illness    
that would1 as certified by a physician1
 place the woman in danger of death     
unless an abortion is performed1        
including a life-endangering physical   
condition caused by or arising from the 
pregnancy itself2 and  7,b7 for which   
the total amount of ,federal and ,state 
expenditures under the ,medicaid program
 under title ,,xix of the ,social       
,security ,act in fiscal year #bjad made
 directly to the entity and to any      
affiliates1 subsidiaries1 successors1 or

 clinics of the entity1 or made to the  
entity and to any affiliates1           
subsidiaries1 successors1 or clinics of 
the entity as part of a nationwide      
health care provider network1 exceeded  
#cej1jjj1jjj4  7#b7 ,direct spending    
,the term direct spending has the       
meaning given that term under section   
#bej7;c7 of the ,balanced ,budget and   
,emergency ,deficit ,control ,act of    
#aihe 7#b ,u4,s4,c4 #ijj7;c774  #bjg4   
,medicaid ,the ,social ,security ,act   
7#db ,u4,s4,c4 #cja et seq47 is         
amended-- 7#a7 in section #aijb--  7,a7 
in subsection 7a77#aj77;,a71 in each of 
clauses 7i77,,viii7 and 7ii77,,xx71 by  
inserting and ending ,december #ca1     
#bjai1 after ,january #a1 #bjad12  7,b7 
in subsection 7a77#dg77;,b71 by         
inserting and provided that any such    
election shall cease to be effective on 
,january #a1 #bjah1 and no such election
 shall be made after that date before   
the semicolon at the end2 and  7,c7 in  
subsection 7l77#b77;,c71 by inserting   

and ending ,december #ca1 #bjai1 after  
,january #a1 #bjad12  7#b7 in section   
#aije--  7,a7 in the first sentence of  
subsection 7b71 by inserting 7#ej       
percent on or after ,january #a1 #bjbj7 
after #ee percent2  7,b7 in subsection  
7y77#a71 by striking the semicolon at   
the end of subparagraph 7,d7 and all    
that follows through thereafter2 and    
7,c7 in subsection 7z77#b7-- 7i7 in     
subparagraph 7,a71 by striking each year
 thereafter and inserting through #bjai2
 and  7ii7 in subparagraph              
7,b77ii77,,vi71 by striking and each    
subsequent year2  7#c7 in section       
#aiae7k77#b71 by striking during the    
period described in paragraph 7#a7 and  
inserting on or after the date referred 
to in paragraph 7#a7 and before ,january
 #a1 #bjbj2  7#d7 in section #aibj7;e71 
by adding at the end the following3     
,this subsection shall not apply after  
,december #ca1 #bjai42  7#e7 in section 
#aicg7;b77#e71 by adding at the end the 
following3 ,this paragraph shall not    

apply after ,december #ca1 #bjai42 and  
7#f7 in section #aidc7;a71 by inserting 
and before ,january #a1 #bjbj1 after    
,january #a1 #bjad14  #bjh4 ,repeal of  
,,dsh allotment reductions ,section     
#aibc7;f7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acifr-#d7;f77 is amended
 by striking paragraphs 7#g7 and 7#h74  
#bji4 ,repeal of the tax on employee    
health insurance premiums and health    
plan benefits  7a7 ,in general ,chapter 
#dc of the ,internal ,revenue ,code of  
#aihf is amended by striking section    
#dihj;,i4  7b7 ,effective date ,the     
amendment made by subsection 7a7 shall  
apply to taxable years beginning after  
,december #ca1 #bjai4  #baj4 ,repeal of 
tax on over-the-counter medications  7a7
 ,h,s,as ,subparagraph 7,a7 of section  
#bbc7;d77#b7 of the ,internal ,revenue  
,code of #aihf is amended by striking   
,such term and all that follows through 
the period4  7b7 ,archer ,m,s,as        
,subparagraph 7,a7 of section           
#bbj7;d77#b7 of the ,internal ,revenue  

,code of #aihf is amended by striking   
,such term and all that follows through 
the period4  7c7 ,health flexible       
spending arrangements and health        
reimbursement arrangements ,section #ajf
 of the ,internal ,revenue ,code of     
#aihf is amended by striking subsection 
7f74  7d7 ,effective dates  7#a7        
,distributions from savings accounts    
,the amendments made by subsections 7a7 
and 7b7 shall apply to amounts paid with
 respect to taxable years beginning     
after ,december #ca1 #bjag4  7#b7       
,reimbursements ,the amendment made by  
subsection 7c7 shall apply to expenses  
incurred with respect to taxable years  
beginning after ,december #ca1 #bjag4   
#baa4 ,repeal of tax on health savings  
accounts  7a7 ,h,s,as ,section          
#bbc7;f77#d77;,a7 of the ,internal      
,revenue ,code of #aihf is amended by   
striking #bj percent and inserting #aj  
percent4  7b7 ,archer ,m,s,as ,section  
#bbj7;f77#d77;,a7 of the ,internal      
,revenue ,code of #aihf is amended by   

striking #bj percent and inserting #ae  
percent4  7c7 ,effective date ,the      
amendments made by this section shall   
apply to distributions made after       
,december #ca1 #bjag4  #bab4 ,repeal of 
limitations on contributions to flexible
 spending accounts  7a7 ,in general     
,section #abe of the ,internal ,revenue 
,code of #aihf is amended by striking   
subsection 7i74  7b7 ,effective date    
,the amendment made by this section     
shall apply to taxable years beginning  
after ,december #ca1 #bjag4  #bac4      
,repeal of tax on prescription          
medications ,subsection 7j7 of section  
#ijjh of the ,patient ,protection and   
,affordable ,care ,act is amended to    
read as follows3  7j7 ,repeal ,this     
section shall apply to calendar years   
beginning after ,december #ca1 #bjaj1   
and ending before ,january #a1 #bjah4  4
  #bad4 ,repeal of medical device excise
 tax  7a7 ,in general ,chapter #cb of   
the ,internal ,revenue ,code of #aihf is
 amended by striking subchapter ,e4  7b7

 ,effective date ,the amendment made by 
this section shall apply to sales in    
calendar quarters beginning after       
,december #ca1 #bjag4  #bae4 ,repeal of 
health insurance tax ,subsection 7j7 of 
section #ijaj of the ,patient           
,protection and ,affordable ,care ,act  
is amended to read as follows3  7j7     
,repeal ,this section shall apply to    
calendar years beginning after ,december
 #ca1 #bjac1 and ending before ,january 
#a1 #bjag4  4  #baf4 ,repeal of         
elimination of deduction for expenses   
allocable to medicare part ,d subsidy   
7a7 ,in general ,section #aci;,a of the 
,internal ,revenue ,code of #aihf is    
amended by adding at the end the        
following new sentence3 ,this section   
shall not be taken into account for     
purposes of determining whether any     
deduction is allowable with respect to  
any cost taken into account in          
determining such payment44  7b7         
,effective date ,the amendment made by  
this section shall apply to taxable     

years beginning after ,december #ca1    
#bjag4  #bag4 ,repeal of chronic care   
tax  7a7 ,in general ,subsection 7a7 of 
section #bac of the ,internal ,revenue  
,code of #aihf is amended by striking   
#aj percent and inserting #g4e percent4 
7b7 ,effective date ,the amendment made 
by this section shall apply to taxable  
years beginning after ,december #ca1    
#bjag4  #bah4 ,repeal of ,medicare tax  
increase  7a7 ,in general ,subsection   
7b7 of section #caja of the ,internal   
,revenue ,code of #aihf is amended to   
read as follows3  7b7 ,hospital         
insurance ,in addition to the tax       
imposed by the preceding subsection1    
there is hereby imposed on the income of
 every individual a tax equal to #a4de  
percent of the wages 7as defined in     
section #caba7;a77 received by such     
individual with respect to employment   
7as defined in section #caba7;b74  4    
7b7 ,,seca ,subsection 7b7 of section   
#adja of the ,internal ,revenue ,code of
 #aihf is amended to read as follows3   

7b7 ,hospital insurance ,in addition to 
the tax imposed by the preceding        
subsection1 there shall be imposed for  
each taxable year1 on the               
self-employment income of every         
individual1 a tax equal to #b4i percent 
of the amount of the self-employment    
income for such taxable year4  4  7c7   
,effective date ,the amendments made by 
this section shall apply with respect to
 remuneration received after1 and       
taxable years beginning after1 ,december
 #ca1 #bjag4  #bai4 ,repeal of tanning  
tax  7a7 ,in general ,the ,internal     
,revenue ,code of #aihf is amended by   
striking chapter #di4  7b7 ,effective   
date ,the amendment made by this section
 shall apply to services performed on or
 after ,december #ca1 #bjag4  #bbj4     
,repeal of net investment tax  7a7 ,in  
general ,subtitle ,a of the ,internal   
,revenue ,code of #aihf is amended by   
striking chapter #b;,a4  7b7 ,effective 
date ,the amendment made by this section
 shall apply to taxable years beginning 

after ,december #ca1 #bjag4  #bba4      
,remuneration ,paragraph 7#f7 of section
 #afb7m7 of the ,internal ,revenue ,code
 of #aihf is amended by adding at the   
end the following new subparagraph3     
7,i7 ,termination ,this paragraph shall 
not apply to taxable years beginning    
after ,december #ca1 #bjag4  4  #bbb4   
,economic substance doctrine  7a7 ,in   
general ,subsection 7o7 of section #ggja
 of the ,internal ,revenue ,code of     
#aihf is repealed4  7b7 ,penalty for    
underpayments ,paragraph 7#f7 of section
 #fffb7;b7 of the ,internal ,revenue    
,code of #aihf is repealed4  7c7        
,increased penalty for nondisclosed     
transactions ,subsection 7i7 of section 
#fffb of the ,internal ,revenue ,code of
 #aihf is repealed4  7d7 ,reasonable    
cause exception for underpayments       
,paragraph 7#b7 of section #fffd7;c7 of 
the ,internal ,revenue ,code of #aihf is
 repealed4  7e7 ,reasonable cause       
exception for nondisclosed transactions 
,paragraph 7#b7 of section #fffd7;d7 of 

the ,internal ,revenue ,code of #aihf is
 repealed4  7f7 ,erroneous claim for    
refund or credit ,subsection 7c7 of     
section #ffgf of the ,internal ,revenue 
,code of #aihf is repealed4  7g7        
,effective date ,the repeals made by    
this section shall apply to transactions
 entered into1 and to underpayments1    
understatements1 or refunds and credits 
attributable to transactions entered    
into1 after ,december #ca1 #bjag4  #bbc4
 ,budgetary savings for extending       
medicare solvency ,as a result of       
policies contained in this ,act1 the    
,secretary of the ,treasury shall       
transfer to the ,federal ,hospital      
,insurance ,trust ,fund under section   
#ahag of the ,social ,security ,act 7#db
 ,u4,s4,c4 #acie;i7 #cgi1cjj1jjj1jjj    
7which represents the full amount of    
on-budget savings during the period of  
fiscal years #bjah through #bjbg7 for   
extending ,medicare solvency1 to remain 
available until expended4