,,ii  #aah? ,,congress  #a/ ,session    
,s4 #caac  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,octob] #bd1 #bjbc,mr4 
,br[n 7= himself1 ,mr4 ,blum5?al1 & ,mr4
 ,fett]man7 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 = fir/ respond]s age  
#ej to #fd :o are sep>at$ f s]vice due  
to retirem5t or disability to buy into  
,m$ic>e4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,exp&+ ,heal? ,c>e ,options 
= ,fir/ ,respond]s ,act4  #b4 ,m$ic>e   
buy-9 option = fir/ respond]s #ej to #fd
 ye>s ( age :o are sep>at$ f s]vice due 
to retirem5t or disability  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$ic>e buy-9 option
 = fir/ respond]s #ej to #fd ye>s ( age 
:o are sep>at$ f s]vice due to retirem5t
 or disability  7a7 ,9 g5]al ,e         
individual :o meets ! requirem5ts       

describ$ 9 subsection 7c7 %all be       
eligible to enroll "u ?is section4  7b7 
,"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  7c7 ,requirem5ts = eligibility  
,! requirem5ts describ$ 9 ?is subsection
 are ! foll[+3 7#a7 ,! individual is a  
resid5t ( ! ,unit$ ,/ates4  7#b7 ,!     
individual is-- 7,a7 a citiz5 or        
national ( ! ,unit$ ,/ates2 or  7,b7 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$ #ej ye>s (
 age b has n atta9$ #fe ye>s ( age4     
7#e7 ,! individual is a qualifi$ fir/   
respond] 7z def9$ 9 subsection 7d77#b774

  7d7 ,def9itions ,9 ?is section3 7#a7  
,fir/ respond] ,! t]m fir/ respond]     
means-- 7,a7 a qualifi$ law en=cem5t    
(fic] 7z def9$ 9 section #ibf;,b7c7 (   
title #ah1 ,unit$ ,/ates ,code72  7,b7  
an employee describ$ 9 clause 7i7 (     
section #gb7t77#aj77;,b7 ( ! ,int]nal   
,rev5ue ,code ( #aihf2 or  7,c7 a ,f$]al
 firefight] describ$ 9 section #hcca7ba7
 or #hdja7ad7 ( title #e1 ,unit$ ,/ates 
,code4  7#b7 ,qualifi$ fir/ respond] ,! 
t]m qualifi$ fir/ respond] means a fir/ 
respond] :o is sep>at$ f s]vice due to  
retirem5t or disability4  7e7 ,enrollm5t
 & cov]age p]iods  7#a7 ,9 g5]al ,!     
,secret>y %all e/abli% enrollm5t &      
cov]age p]iods = individuals :o enroll  
"u ?is section4  7#b7 ,coord9ation ,su* 
p]iods %all be e/abli%$ 9 coord9ation ) 
! enrollm5t & cov]age p]iods = plans    
(f]$ "u an ,ex*ange e/abli%$ "u title ,i
 ( ! ,pati5t ,protection & ,af=dable    
,c>e ,act & plans "u p>ts ,c & ,d4 ,if !
 ,secret>y det]m9es appropriate1 !      
,secret>y may exp& su* enrollm5t p]iods 

beyond ! enrollm5t p]iods "u su* an     
,ex*ange or "u p>ts ,c & ,d4  7#c7      
,beg9n+ ( cov]age & special enrollm5t   
p]iods ,! ,secret>y %all e/abli% su*    
p]iods s t cov]age "u ?is section %all  
fir/ beg9 on ,janu>y #a ( ! fir/ ye>    
beg9n+ at lea/ #a ye> aft] ! date ( !   
enactm5t ( ?is section & %all include   
special enrollm5t p]iods1 9 accordance )
 section #aee4dbj ( title #de ( ! ,code 
( ,f$]al ,regulations1 t are applicable 
to qualifi$ heal? plans (f]$ ?r\gh an   
,ex*ange4  7f7 ,premium  7#a7 ,am\nt (  
mon?ly premiums ,! ,secret>y %all       
7beg9n+ = ! fir/ ye> t beg9s m ?an #a   
ye> aft] ! date ( enactm5t ( ?is        
section7 det]m9e a mon?ly premium = all 
individuals enroll$ "u ?is section4 ,su*
 mon?ly premium %all be equal to #aab ( 
! 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
  7g7 ,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$ic>e          
,prescription ,drug ,acc\nt )9 su* ,tru/
 ,fund7 9 su* proportion z ! ,secret>y  
det]m9es appropriate4  7h7 ,n eligible =
 ,m$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  7i7 ,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 ( #aihf1 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     
7#c7 ,second l[e/ co/ silv] plan ,!     
,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 ( ! ,int]nal  
,rev5ue ,code ( #aihf4  7#d7            
,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  7#e7 ,m$icaid manag$ 
c>e ,/ates are prohibit$ f buy+ _!      
,m$icaid b5efici>ies ages #ej to #fd    
into ,m$ic>e "u ?is section1 &          

individuals o!rwise eligible = enrollm5t
 "u a ,/ate plan "u title ,,xix are     
prohibit$ f cov]age "u ?is title        
pursuant to enrollm5t "u ?is section4 ,!
 prec$+ s5t5ce %all n apply to ,m$icaid 
b5efici>ies ^: ,m$icaid cov]age or      
eligibility does n meet ! def9ition (   
m9imum ess5tial cov]age "u a            
gov]nm5t-sponsor$ program "u section    
#a4ejjj;,a-#b ( title #bf1 ,code (      
,f$]al ,regulations 7or any successor   
regulation74  7#f7 ,coord9ation ) m>ket 
re=ms1 etc ,not)/&+ ,treasury ,notice   
#bjae-ag1 no provision ( law %all prev5t
 an employ] f ma9ta9+ an arrangem5t "u  
:i* ! employ] pays or reimburses any    
portion ( ! premiums = cov]age "u ?is   
section = retir$ employees ( ! employ]1 
or prev5t su* paym5t or reimbursem5t f  
be+ exclud$ f ! gross income ( !        
individual enroll$ 9 su* cov]age =      
purposes ( ! ,int]nal ,rev5ue ,code (   
#aihf4  7j7 ,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+ #ej = #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$ #ej 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$ic>e           
supplem5tal policy7 :5 ! individual     
atta9s #fe ye>s ( age4  7k7 ,ov]sight   
,!re is e/abli%$ an advisory committee  
to be kn[n z ! ,m$ic>e ,buy ,9 ,ov]sight
 ,bo>d to monitor & ov]see !            
implem5tation ( ?is section1 includ+ !  
exp]i5ce ( ! individuals enroll+ "u ?is 
section4 ,! ,m$ic>e ,buy ,9 ,ov]sight   

,bo>d %all h memb]s t include           
repres5tatives ( insur]s1 actu>ies1     
consum] advocacy organizations1 &       
individuals repres5t+ ! fir/ respond]   
community1 & %all make p]iodic          
recomm5dations = ! cont9ual improvem5t (
 ! implem5tation ( ?is section z well z 
! relation%ip ( enrollm5t "u ?is section
 to o!r heal? c>e programs4  7l7        
,outrea* & enrollm5t  7#a7 ,9 g5]al     
,dur+ ! p]iod t beg9s on ,janu>y #a1    
#bjbd1 & ends on ,decemb] #ca1 #bjbf1 ! 
,secret>y %all aw>d grants to eligible  
entities = ! foll[+ purposes3 7,a7      
,outrea* & enrollm5t ,to c>ry out       
outrea*1 public education activities1 & 
enrollm5t activities to raise aw>5ess ( 
! availability (1 & enc\rage1 enrollm5t 
"u ?is section4  7,b7 ,assi/+           
individuals' transition "u ?is section  
,to provide assi/ance to individuals to 
enroll "u ?is section4  7,c7 ,rais+     
aw>5ess ( premium assi/ance & co/-%>+   
r$uctions ,to di/ribute fair & imp>tial 
in=mation conc]n+ enrollm5t "u ?is      

section & ! availability ( premium      
assi/ance tax cr$its "u section #cf;,b (
 ! ,int]nal ,rev5ue ,code ( #aihf &     
co/-%>+ r$uctions "u section #adjb ( !  
,pati5t ,protection & ,af=dable ,c>e    
,act1 & to assi/ eligible individuals 9 
apply+ = su* tax cr$its & co/-%>+       
r$uctions4  7#b7 ,eligible entities     
7,a7 ,9 g5]al ,9 ?is subsection1 ! t]m  
eligible entity means-- 7i7 a ,/ate2    
7ii7 a nonpr(it community-bas$          
organization2 or  7iii7 a nonpr(it fir/ 
respond] organization4  7,b7 ,enrollm5t 
ag5ts ,su* t]m includes a lic5s$        
indep5d5t insurance ag5t or brok] t has 
an arrangem5t ) a ,/ate1 nonpr(it       
community-bas$ organization1 or nonpr(it
 fir/ respond] organization to enroll   
eligible individuals "u ?is section4    
7,c7 ,exclusions ,su* t]m does n include
 an entity t-- 7i7 is a heal? insurance 
issu]2 or  7ii7 receives any            
consid]ation1 ei!r directly or          
indirectly1 f any heal? insurance issu] 
9 connection ) ! enrollm5t ( any        

individuals "u ?is section4  7#c7       
,priority ,9 aw>d+ grants "u ?is        
subsection1 ! ,secret>y %all give       
priority to aw>d+ grants to ,/ates or   
eligible entities 9 ,/ates t h          
geographic rat+ areas at risk ( hav+ no 
qualifi$ heal? plans 9 ! individual     
m>ket4  7#d7 ,fund+ ,= purposes ( c>ry+ 
out ?is subsection1 !re is appropriat$  
to ! ,secret>y1 out ( any moneys 9 !    
,treasury n o!rwise appropriat$1 su*    
sums z are necess>y = fiscal ye> #bjbd &
 = ea* subsequ5t fiscal ye>4  7m7 ,no   
effect on b5efits = individuals o!rwise 
eligible or on tru/ funds ,! ,secret>y  
%all implem5t ! provisions ( ?is section
 9 su* a mann] to ensure t su*          
provisions-- 7#a7 h no effect on !      
b5efits "u ?is title = individuals :o   
are entitl$ 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  7n7 ,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 companies1 &        
organizations repres5t+ fir/ respond]s4 
4