Title VI, SEC. 6002. BOARD DETERMINATION OF NATIONAL PER CAPITA BASELINE 
PREMIUM TARGET. 
      (a) In General. Not later than January 1, 1995, the Board shall determine 
    a national per capita baseline premium target. Such target is equal to 

        (1) the national average per capita current coverage health 
      expenditures (determined under subsection (b)), 

        (2) updated under subsection (c). 

      (b) Determination of National Average Per Capita Current Coverage Health 
    Expenditures. 

        (1) In general. The Board shall determine the national average per 
      capita current coverage health expenditures equal to 

          (A) total covered current health care expenditures (described in 
        paragraph (2)), divided by 

          (B) the estimated population in the United States of regional 
        alliance eligible individuals (as determined by the Board as of the 
        1993 under subsection (c)(3)) for whom such expenditures were 
        determined. 

          The population under subparagraph (B) shall not include SSI 
        recipients or AFDC recipients. 

        (2) Current health care expenditures. For purposes of paragraph (1)(A), 
      the Board shall determine current health care expenditures as follows: 

          (A) Determination of total expenditures. The Board shall first 
        determine the amount of total payments made for items and services 
        included in the comprehensive benefit package (determined without 
        regard to cost sharing) in the United States in 1993. 

          (B) Removal of certain expenditures not to be covered through 
        regional alliances. The amount so determined shall be decreased by the 
        proportion of such amount that is attributable to any of the following: 

            (i) Medicare beneficiaries (other than such beneficiaries who are 
          regional alliance eligible individuals). 

            (ii) AFDC recipients or SSI recipients. 

            (iii) Expenditures which are paid for through workers' compensation 
          or automobile or other liability insurance. 

            (iv) Expenditures by parties (including the Federal Government) 
          that the Board determines will not be payable by regional alliance 
          health plans for coverage of the comprehensive benefit package under 
          this Act. 

          (C) Addition of projected expenditures for uninsured and underinsured 
        individuals. The amount so determined and adjusted shall be increased 
        to take into account increased utilization of, and expenditures for, 
        items and services covered under the comprehensive benefit package 
        likely to occur, as a result of coverage under a regional alliance 
        health plan of individuals who, as of 1993 were uninsured or 
        underinsured with respect to the comprehensive benefit package. In 
        making such determination, such expenditures shall be based on the 
        estimated average cost for such services in 1993 (and not on private 
        payment rates established for such services). In making such 
        determination, the estimated amount of uncompensated care in 1993 shall 
        be removed. 

          (D) Addition of health plan and alliance costs of administration. 

            (i) In general. The amount so determined and adjusted shall be 
          increased by an estimated percentage (determined by the Board, but no 
          more than 15 percent) that reflects the proportion of premiums that 
          are required for health plan and regional alliance administration 
          (including regional alliance costs for administration of 
          income-related premium discounts and cost sharing reductions) and for 
          State premium taxes (which taxes shall be limited to such amounts in 
          1993 as are attributable to the health benefits to be included in the 
          comprehensive benefit package). 

          (E) Decrease for cost sharing. The amount so determined and adjusted 
        shall be decreased by a percentage that reflects (i) the estimated 
        average percentage of total amounts payable for items and services 
        covered under the comprehensive benefit package that will be payments 
        in the form of cost sharing under a high cost sharing plan, and (ii) 
        the percentage reduction in utilization estimated to result from the 
        application of high cost sharing. 

        (3) Special rules. 

          (A) Benefits used. The determinations under this section shall be 
        based on the comprehensive benefit package as in effect in 1996. 

          (B) Assuming no change in expenditure pattern. The determination 
        under paragraph (2) shall be made without regard to any change in the 
        pattern of expenditures that may result from the enrollment of AFDC 
        recipients and SSI recipients in regional alliance health plans. 

          (C) Eligible individuals. In this subsection, the determination of 
        who are regional alliance eligible individuals under this subsection 
        shall be made as though this Act was fully in effect in each State as 
        of 1993. 

      (c) Updating. 

        (1) In general. Subject to paragraph (3), the Board shall update the 
      amount determined under subsection (b)(1) for each of 1994, 1995, and 
      1996 by the appropriate update factor described in paragraph (2) for the 
      year. 

        (2) Appropriate update factor. In paragraph (1), the appropriate update 
      factor for a year is 1 plus the annual percentage increase for the year 
      (as determined by the Administrator of the Health Care Financing 
      Administration, based on actual or projected information) in private 
      sector health care spending for items and services included in the 
      comprehensive benefit package (as of 1996). 

        (3) Limit. The total, cumulative update under this subsection shall not 
      exceed 15 percent.