Short answer: Since when is fraud punishable by physical harm or death?
Longer answer, by story: So you’re on a plane and you get the feeling the pilot is up front drinking heavily and maybe playing strip poker. Random turns, funny noises – things just aren’t right. Then you spot a flock of geese ahead. A big flock of geese.
You’d buy parachute insurance if someone walked around selling it and he had a partner in the back with a pile of chutes, wouldn’t you?
“Just fill out this weirdly complicated application,” he says. “And give me whatever cash you have on you.” So, you do. Of course you do. What other option do you have?
Things get worse. ‘Funny’ noises turns into ‘alarming’ noises so you head back to claim your parachute and none too soon if the smell of cooked goose is any indication.
Not so fast, Sparky.
“I see a problem here on your application,” the parachute insurer tells you. You stand back and watch in horror as he tells quite a few other people the same thing, even though the guy in the back has plenty of parachutes. More than enough for everyone.
Unbeknownst to you, the application contained some trick questions. And, let’s face it; some people just don’t put a lot of effort into filling things out. Their own lazy fault.
Sure, it seems a little unfair, but how else can the chute insurer increase his profits if he doesn’t take a few chutes with him for the next plane? People only have so much money to give. So, the insurer and his partner (their chutes went on first, of course) live to provide chute insurance, and just a couple fewer chutes, to the next plane load of passengers. Their stockholders will be happy. You, not so much.
Is this a business we’d allow in the US? Especially if we figured out that we as a country could easily put enough chutes on every plane for much cheaper than the insurer ever could?
Hello, HR 676, Medicare4All. Simple, fiscally responsible, people like it: Covers everyone, no one ever rescinded, dumped or bankrupted because they got sick EVER AGAIN. Parachutes for everyone!
People on Medicare are happier with their coverage than are people on private insurance. And we can’t even ask the people who bought insurance, only to go down with the plane without a parachute how they feel. Because I’m thinking “not thrilled” would be the answer there.
Yes, the parachute insurers and providers didn’t cause the plane to go down, true. Bad goose luck and drunk pilots sometimes just happen.
Do people have a right to parachutes? To have a chance when the plane starts making funny noises? I think so, of course, but let's face it: 'rights' are arbitrary things We the People decide. Medicare was signed into law for seniors. The 14th Amendment promises us equal protection of the laws. Should that include health care? We decide. You and me.
If you asked the passengers on the bad luck plane if parachutes were a right, what do you think their answer would be?
Well, we're all on that plane already. Some of us even have drunk pilots playing strip poker. Are chutes a right? If the plane lands safely is it okay that the insurers took all our money? It's entirely up to us. Despite how it feels sometimes we can have whatever we want if enough of us stand together and demand it.
The truth is we're paying for Universal Coverage already (twice more what other countries pay for it, in fact). We're just not getting it.
If we're paying for it already doesn't it make sense that we give it a try?
If you were making car payments on a car parked in an InsurCEO's driveway,would you turn down the offer to drive it?
Yours,
Robin
Most individual health care dollars are spent in the later years of life, the period of time during which people receive care via taxpayer funded single payer government health care, which they love enough to storm town hall meetings all over the country defending. It's a simple, cost-effective program that people like.
Since the taxpayer, through this and other programs, pays for individual care when health care is most costly, why in the world would the premiums of the healthy primarily go to a separate private entity that operates far less efficiently and denies, rescinds & bankrupts us at every turn? It makes no sense and that is why I support HR 676 USNHC Medicare for all.
9.26.2009
9.07.2009
HR676 for twitter readers...:~)
I
111TH CONGRESS
1ST SESSION H. R. 676
To provide for comprehensive health insurance coverage for all United States
residents, improved health care delivery, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 26, 2009
Mr. CONYERS (for himself, Mr. KUCINICH, Ms. WATSON, Mr. ELLISON, Mr.
HINCHEY, Mr. DAVIS of Illinois, Ms. BALDWIN, Ms. LEE of California,
Mr. MASSA, Mr. NADLER of New York, Mr. MCDERMOTT, Mr. DOYLE,
Mr. GUTIERREZ, Mr. OLVER, Ms. KAPTUR, Ms. JACKSON-LEE of Texas,
Mr. ENGEL, Mr. MEEKS of New York, Ms. CLARKE, Mr. FARR, Mrs.
NAPOLITANO, Ms. PINGREE of Maine, Mr. TONKO, Ms. EDWARDS of
Maryland, Mr. GRIJALVA, Mr. BERMAN, Mr. DELAHUNT, Mr. CLAY, Ms.
KILPATRICK of Michigan, Ms. WOOLSEY, and Mr. COHEN) introduced the
following bill; which was referred to the Committee on Energy and Commerce,
and in addition to the Committees on Ways and Means and Natural
Resources, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the jurisdiction
of the committee concerned
A BILL
To provide for comprehensive health insurance coverage for
all United States residents, improved health care delivery,
and for other purposes.
1 Be it enacted by the Senate and House of Representa2
tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
2 (a) SHORT TITLE.—This Act may be cited as the
3 ‘‘United States National Health Care Act or the Ex4
panded and Improved Medicare for All Act’’.
5 (b) TABLE OF CONTENTS.—The table of contents of
6 this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions and terms.
TITLE I—ELIGIBILITY AND BENEFITS
Sec. 101. Eligibility and registration.
Sec. 102. Benefits and portability.
Sec. 103. Qualification of participating providers.
Sec. 104. Prohibition against duplicating coverage.
TITLE II—FINANCES
Subtitle A—Budgeting and Payments
Sec. 201. Budgeting process.
Sec. 202. Payment of providers and health care clinicians.
Sec. 203. Payment for long-term care.
Sec. 204. Mental health services.
Sec. 205. Payment for prescription medications, medical supplies, and medically
necessary assistive equipment.
Sec. 206. Consultation in establishing reimbursement levels.
Subtitle B—Funding
Sec. 211. Overview: funding the USNHC Program.
Sec. 212. Appropriations for existing programs.
TITLE III—ADMINISTRATION
Sec. 301. Public administration; appointment of Director.
Sec. 302. Office of Quality Control.
Sec. 303. Regional and State administration; employment of displaced clerical
workers.
Sec. 304. Confidential Electronic Patient Record System.
Sec. 305. National Board of Universal Quality and Access.
TITLE IV—ADDITIONAL PROVISIONS
Sec. 401. Treatment of VA and IHS health programs.
Sec. 402. Public health and prevention.
Sec. 403. Reduction in health disparities.
TITLE V—EFFECTIVE DATE
Sec. 501. Effective date.
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1 SEC. 2. DEFINITIONS AND TERMS.
2 In this Act:
3 (1) USNHC PROGRAM; PROGRAM.—The terms
4 ‘‘USNHC Program’’ and ‘‘Program’’ mean the pro5
gram of benefits provided under this Act and, unless
6 the context otherwise requires, the Secretary with
7 respect to functions relating to carrying out such
8 program.
9 (2) NATIONAL BOARD OF UNIVERSAL QUALITY
10 AND ACCESS.—The term ‘‘National Board of Uni11
versal Quality and Access’’ means such Board estab12
lished under section 305.
13 (3) REGIONAL OFFICE.—The term ‘‘regional of14
fice’’ means a regional office established under sec15
tion 303.
16 (4) SECRETARY.—The term ‘‘Secretary’’ means
17 the Secretary of Health and Human Services.
18 (5) DIRECTOR.—The term ‘‘Director’’ means,
19 in relation to the Program, the Director appointed
20 under section 301.
21 TITLE I—ELIGIBILITY AND
22 BENEFITS
23 SEC. 101. ELIGIBILITY AND REGISTRATION.
24 (a) IN GENERAL.—All individuals residing in the
25 United States (including any territory of the United
26 States) are covered under the USNHC Program entitling
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1 them to a universal, best quality standard of care. Each
2 such individual shall receive a card with a unique number
3 in the mail. An individual’s social security number shall
4 not be used for purposes of registration under this section.
5 (b) REGISTRATION.—Individuals and families shall
6 receive a United States National Health Insurance Card
7 in the mail, after filling out a United States National
8 Health Insurance application form at a health care pro9
vider. Such application form shall be no more than 2 pages
10 long.
11 (c) PRESUMPTION.—Individuals who present them12
selves for covered services from a participating provider
13 shall be presumed to be eligible for benefits under this Act,
14 but shall complete an application for benefits in order to
15 receive a United States National Health Insurance Card
16 and have payment made for such benefits.
17 (d) RESIDENCY CRITERIA.—The Secretary shall pro18
mulgate a rule that provides criteria for determining resi19
dency for eligibility purposes under the USNHC Program.
20 (e) COVERAGE FOR VISITORS.—The Secretary shall
21 promulgate a rule regarding visitors from other countries
22 who seek premeditated non-emergency surgical proce23
dures. Such a rule should facilitate the establishment of
24 country-to-country reimbursement arrangements or self
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1 pay arrangements between the visitor and the provider of
2 care.
3 SEC. 102. BENEFITS AND PORTABILITY.
4 (a) IN GENERAL.—The health care benefits under
5 this Act cover all medically necessary services, including
6 at least the following:
7 (1) Primary care and prevention.
8 (2) Inpatient care.
9 (3) Outpatient care.
10 (4) Emergency care.
11 (5) Prescription drugs.
12 (6) Durable medical equipment.
13 (7) Long-term care.
14 (8) Palliative care.
15 (9) Mental health services.
16 (10) The full scope of dental services (other
17 than cosmetic dentistry).
18 (11) Substance abuse treatment services.
19 (12) Chiropractic services.
20 (13) Basic vision care and vision correction
21 (other than laser vision correction for cosmetic pur22
poses).
23 (14) Hearing services, including coverage of
24 hearing aids.
25 (15) Podiatric care.
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1 (b) PORTABILITY.—Such benefits are available
2 through any licensed health care clinician anywhere in the
3 United States that is legally qualified to provide the bene4
fits.
5 (c) NO COST-SHARING.—No deductibles, copay6
ments, coinsurance, or other cost-sharing shall be imposed
7 with respect to covered benefits.
8 SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.
9 (a) REQUIREMENT TO BE PUBLIC OR NON-PROF10
IT.—
11 (1) IN GENERAL.—No institution may be a par12
ticipating provider unless it is a public or not-for13
profit institution. Private physicians, private clinics,
14 and private health care providers shall continue to
15 operate as private entities, but are prohibited from
16 being investor owned.
17 (2) CONVERSION OF INVESTOR-OWNED PRO18
VIDERS.—For-profit providers of care opting to par19
ticipate shall be required to convert to not-for-profit
20 status.
21 (3) PRIVATE DELIVERY OF CARE REQUIRE22
MENT.—For-profit providers of care that convert to
23 non-profit status shall remain privately owned and
24 operated entities.
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1 (4) COMPENSATION FOR CONVERSION.—The
2 owners of such for-profit providers shall be com3
pensated for reasonable financial losses incurred as
4 a result of the conversion from for-profit to non5
profit status.
6 (5) FUNDING.—There are authorized to be ap7
propriated from the Treasury such sums as are nec8
essary to compensate investor-owned providers as
9 provided for under paragraph (3).
10 (6) REQUIREMENTS.—The payments to owners
11 of converting for-profit providers shall occur during
12 a 15-year period, through the sale of U.S. Treasury
13 Bonds. Payment for conversions under paragraph
14 (3) shall not be made for loss of business profits.
15 (7) MECHANISM FOR CONVERSION PROCESS.—
16 The Secretary shall promulgate a rule to provide a
17 mechanism to further the timely, efficient, and fea18
sible conversion of for-profit providers of care.
19 (b) QUALITY STANDARDS.—
20 (1) IN GENERAL.—Health care delivery facili21
ties must meet State quality and licensing guidelines
22 as a condition of participation under such program,
23 including guidelines regarding safe staffing and
24 quality of care.
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1 (2) LICENSURE REQUIREMENTS.—Participating
2 clinicians must be licensed in their State of practice
3 and meet the quality standards for their area of
4 care. No clinician whose license is under suspension
5 or who is under disciplinary action in any State may
6 be a participating provider.
7 (c) PARTICIPATION OF HEALTH MAINTENANCE OR8
GANIZATIONS.—
9 (1) IN GENERAL.—Non-profit health mainte10
nance organizations that deliver care in their own
11 facilities and employ clinicians on a salaried basis
12 may participate in the program and receive global
13 budgets or capitation payments as specified in sec14
tion 202.
15 (2) EXCLUSION OF CERTAIN HEALTH MAINTE16
NANCE ORGANIZATIONS.—Other health maintenance
17 organizations, including those which principally con18
tract to pay for services delivered by non-employees,
19 shall be classified as insurance plans. Such organiza20
tions shall not be participating providers, and are
21 subject to the regulations promulgated by reason of
22 section 104(a) (relating to prohibition against dupli23
cating coverage).
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1 (d) FREEDOM OF CHOICE.—Patients shall have free
2 choice of participating physicians and other clinicians,
3 hospitals, and inpatient care facilities.
4 SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE.
5 (a) IN GENERAL.—It is unlawful for a private health
6 insurer to sell health insurance coverage that duplicates
7 the benefits provided under this Act.
8 (b) CONSTRUCTION.—Nothing in this Act shall be
9 construed as prohibiting the sale of health insurance cov10
erage for any additional benefits not covered by this Act,
11 such as for cosmetic surgery or other services and items
12 that are not medically necessary.
13 TITLE II—FINANCES
14 Subtitle A—Budgeting and
15 Payments
16 SEC. 201. BUDGETING PROCESS.
17 (a) ESTABLISHMENT OF OPERATING BUDGET AND
18 CAPITAL EXPENDITURES BUDGET.—
19 (1) IN GENERAL.—To carry out this Act there
20 are established on an annual basis consistent with
21 this title—
22 (A) an operating budget, including
23 amounts for optimal physician, nurse, and other
24 health care professional staffing;
25 (B) a capital expenditures budget;
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1 (C) reimbursement levels for providers con2
sistent with subtitle B; and
3 (D) a health professional education budget,
4 including amounts for the continued funding of
5 resident physician training programs.
6 (2) REGIONAL ALLOCATION.—After Congress
7 appropriates amounts for the annual budget for the
8 USNHC Program, the Director shall provide the re9
gional offices with an annual funding allotment to
10 cover the costs of each region’s expenditures. Such
11 allotment shall cover global budgets, reimbursements
12 to clinicians, health professional education, and cap13
ital expenditures. Regional offices may receive addi14
tional funds from the national program at the dis15
cretion of the Director.
16 (b) OPERATING BUDGET.—The operating budget
17 shall be used for—
18 (1) payment for services rendered by physicians
19 and other clinicians;
20 (2) global budgets for institutional providers;
21 (3) capitation payments for capitated groups;
22 and
23 (4) administration of the Program.
24 (c) CAPITAL EXPENDITURES BUDGET.—The capital
25 expenditures budget shall be used for funds needed for—
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1 (1) the construction or renovation of health fa2
cilities; and
3 (2) for major equipment purchases.
4 (d) PROHIBITION AGAINST CO-MINGLING OPER5
ATIONS AND CAPITAL IMPROVEMENT FUNDS.—It is pro6
hibited to use funds under this Act that are earmarked—
7 (1) for operations for capital expenditures; or
8 (2) for capital expenditures for operations.
9 SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLI10
NICIANS.
11 (a) ESTABLISHING GLOBAL BUDGETS; MONTHLY
12 LUMP SUM.—
13 (1) IN GENERAL.—The USNHC Program,
14 through its regional offices, shall pay each institu15
tional provider of care, including hospitals, nursing
16 homes, community or migrant health centers, home
17 care agencies, or other institutional providers or pre18
paid group practices, a monthly lump sum to cover
19 all operating expenses under a global budget.
20 (2) ESTABLISHMENT OF GLOBAL BUDGETS.—
21 The global budget of a provider shall be set through
22 negotiations between providers, State directors, and
23 regional directors, but are subject to the approval of
24 the Director. The budget shall be negotiated annu25
ally, based on past expenditures, projected changes
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1 in levels of services, wages and input, costs, a pro2
vider’s maximum capacity to provide care, and pro3
posed new and innovative programs.
4 (b) THREE PAYMENT OPTIONS FOR PHYSICIANS AND
5 CERTAIN OTHER HEALTH PROFESSIONALS.—
6 (1) IN GENERAL.—The Program shall pay phy7
sicians, dentists, doctors of osteopathy, pharmacists,
8 psychologists, chiropractors, doctors of optometry,
9 nurse practitioners, nurse midwives, physicians’ as10
sistants, and other advanced practice clinicians as li11
censed and regulated by the States by the following
12 payment methods:
13 (A) Fee for service payment under para14
graph (2).
15 (B) Salaried positions in institutions re16
ceiving global budgets under paragraph (3).
17 (C) Salaried positions within group prac18
tices or non-profit health maintenance organiza19
tions receiving capitation payments under para20
graph (4).
21 (2) FEE FOR SERVICE.—
22 (A) IN GENERAL.—The Program shall ne23
gotiate a simplified fee schedule that is fair and
24 optimal with representatives of physicians and
25 other clinicians, after close consultation with
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1 the National Board of Universal Quality and
2 Access and regional and State directors. Ini3
tially, the current prevailing fees or reimburse4
ment would be the basis for the fee negotiation
5 for all professional services covered under this
6 Act.
7 (B) CONSIDERATIONS.—In establishing
8 such schedule, the Director shall take into con9
sideration the following:
10 (i) The need for a uniform national
11 standard.
12 (ii) The goal of ensuring that physi13
cians, clinicians, pharmacists, and other
14 medical professionals be compensated at a
15 rate which reflects their expertise and the
16 value of their services, regardless of geo17
graphic region and past fee schedules.
18 (C) STATE PHYSICIAN PRACTICE REVIEW
19 BOARDS.—The State director for each State, in
20 consultation with representatives of the physi21
cian community of that State, shall establish
22 and appoint a physician practice review board
23 to assure quality, cost effectiveness, and fair re24
imbursements for physician delivered services.
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1 (D) FINAL GUIDELINES.—The Director
2 shall be responsible for promulgating final
3 guidelines to all providers.
4 (E) BILLING.—Under this Act physicians
5 shall submit bills to the regional director on a
6 simple form, or via computer. Interest shall be
7 paid to providers who are not reimbursed within
8 30 days of submission.
9 (F) NO BALANCE BILLING.—Licensed
10 health care clinicians who accept any payment
11 from the USNHC Program may not bill any
12 patient for any covered service.
13 (G) UNIFORM COMPUTER ELECTRONIC
14 BILLING SYSTEM.—The Director shall create a
15 uniform computerized electronic billing system,
16 including those areas of the United States
17 where electronic billing is not yet established.
18 (3) SALARIES WITHIN INSTITUTIONS RECEIVING
19 GLOBAL BUDGETS.—
20 (A) IN GENERAL.—In the case of an insti21
tution, such as a hospital, health center, group
22 practice, community and migrant health center,
23 or a home care agency that elects to be paid a
24 monthly global budget for the delivery of health
25 care as well as for education and prevention
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1 programs, physicians and other clinicians em2
ployed by such institutions shall be reimbursed
3 through a salary included as part of such a
4 budget.
5 (B) SALARY RANGES.—Salary ranges for
6 health care providers shall be determined in the
7 same way as fee schedules under paragraph (2).
8 (4) SALARIES WITHIN CAPITATED GROUPS.—
9 (A) IN GENERAL.—Health maintenance or10
ganizations, group practices, and other institu11
tions may elect to be paid capitation payments
12 to cover all outpatient, physician, and medical
13 home care provided to individuals enrolled to
14 receive benefits through the organization or en15
tity.
16 (B) SCOPE.—Such capitation may include
17 the costs of services of licensed physicians and
18 other licensed, independent practitioners pro19
vided to inpatients. Other costs of inpatient and
20 institutional care shall be excluded from capita21
tion payments, and shall be covered under insti22
tutions’ global budgets.
23 (C) PROHIBITION OF SELECTIVE ENROLL24
MENT.—Patients shall be permitted to enroll or
25 disenroll from such organizations or entities
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1 without discrimination and with appropriate no2
tice.
3 (D) HEALTH MAINTENANCE ORGANIZA4
TIONS.—Under this Act—
5 (i) health maintenance organizations
6 shall be required to reimburse physicians
7 based on a salary; and
8 (ii) financial incentives between such
9 organizations and physicians based on uti10
lization are prohibited.
11 SEC. 203. PAYMENT FOR LONG-TERM CARE.
12 (a) ALLOTMENT FOR REGIONS.—The Program shall
13 provide for each region a single budgetary allotment to
14 cover a full array of long-term care services under this
15 Act.
16 (b) REGIONAL BUDGETS.—Each region shall provide
17 a global budget to local long-term care providers for the
18 full range of needed services, including in-home, nursing
19 home, and community based care.
20 (c) BASIS FOR BUDGETS.—Budgets for long-term
21 care services under this section shall be based on past ex22
penditures, financial and clinical performance, utilization,
23 and projected changes in service, wages, and other related
24 factors.
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1 (d) FAVORING NON-INSTITUTIONAL CARE.—All ef2
forts shall be made under this Act to provide long-term
3 care in a home- or community-based setting, as opposed
4 to institutional care.
5 SEC. 204. MENTAL HEALTH SERVICES.
6 (a) IN GENERAL.—The Program shall provide cov7
erage for all medically necessary mental health care on
8 the same basis as the coverage for other conditions. Li9
censed mental health clinicians shall be paid in the same
10 manner as specified for other health professionals, as pro11
vided for in section 202(b).
12 (b) FAVORING COMMUNITY-BASED CARE.—The
13 USNHC Program shall cover supportive residences, occu14
pational therapy, and ongoing mental health and coun15
seling services outside the hospital for patients with seri16
ous mental illness. In all cases the highest quality and
17 most effective care shall be delivered, and, for some indi18
viduals, this may mean institutional care.
19 SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS,
20 MEDICAL SUPPLIES, AND MEDICALLY NEC21
ESSARY ASSISTIVE EQUIPMENT.
22 (a) NEGOTIATED PRICES.—The prices to be paid
23 each year under this Act for covered pharmaceuticals,
24 medical supplies, and medically necessary assistive equip25
ment shall be negotiated annually by the Program.
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1 (b) PRESCRIPTION DRUG FORMULARY.—
2 (1) IN GENERAL.—The Program shall establish
3 a prescription drug formulary system, which shall
4 encourage best-practices in prescribing and discour5
age the use of ineffective, dangerous, or excessively
6 costly medications when better alternatives are avail7
able.
8 (2) PROMOTION OF USE OF GENERICS.—The
9 formulary shall promote the use of generic medica10
tions but allow the use of brand-name and off-for11
mulary medications.
12 (3) FORMULARY UPDATES AND PETITION
13 RIGHTS.—The formulary shall be updated frequently
14 and clinicians and patients may petition their region
15 or the Director to add new pharmaceuticals or to re16
move ineffective or dangerous medications from the
17 formulary.
18 SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSE19
MENT LEVELS.
20 Reimbursement levels under this subtitle shall be set
21 after close consultation with regional and State Directors
22 and after the annual meeting of National Board of Uni23
versal Quality and Access.
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1 Subtitle B—Funding
2 SEC. 211. OVERVIEW: FUNDING THE USNHC PROGRAM.
3 (a) IN GENERAL.—The USNHC Program is to be
4 funded as provided in subsection (c)(1).
5 (b) USNHC TRUST FUND.—There shall be estab6
lished a USNHC Trust Fund in which funds provided
7 under this section are deposited and from which expendi8
tures under this Act are made.
9 (c) FUNDING.—
10 (1) IN GENERAL.—There are appropriated to
11 the USNHC Trust Fund amounts sufficient to carry
12 out this Act from the following sources:
13 (A) Existing sources of Federal Govern14
ment revenues for health care.
15 (B) Increasing personal income taxes on
16 the top 5 percent income earners.
17 (C) Instituting a modest and progressive
18 excise tax on payroll and self-employment in19
come.
20 (D) Instituting a small tax on stock and
21 bond transactions.
22 (2) SYSTEM SAVINGS AS A SOURCE OF FINANC23
ING.—Funding otherwise required for the Program
24 is reduced as a result of—
25 (A) vastly reducing paperwork;
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1 (B) requiring a rational bulk procurement
2 of medications under section 205(a); and
3 (C) improved access to preventive health
4 care.
5 (3) ADDITIONAL ANNUAL APPROPRIATIONS TO
6 USNHC PROGRAM.—Additional sums are authorized
7 to be appropriated annually as needed to maintain
8 maximum quality, efficiency, and access under the
9 Program.
10 SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS.
11 Notwithstanding any other provision of law, there are
12 hereby transferred and appropriated to carry out this Act,
13 amounts from the Treasury equivalent to the amounts the
14 Secretary estimates would have been appropriated and ex15
pended for Federal public health care programs, including
16 funds that would have been appropriated under the Medi17
care program under title XVIII of the Social Security Act,
18 under the Medicaid program under title XIX of such Act,
19 and under the Children’s Health Insurance Program
20 under title XXI of such Act.
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1 TITLE III—ADMINISTRATION
2 SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DI3
RECTOR.
4 (a) IN GENERAL.—Except as otherwise specifically
5 provided, this Act shall be administered by the Secretary
6 through a Director appointed by the Secretary.
7 (b) LONG-TERM CARE.—The Director shall appoint
8 a director for long-term care who shall be responsible for
9 administration of this Act and ensuring the availability
10 and accessibility of high quality long-term care services.
11 (c) MENTAL HEALTH.—The Director shall appoint a
12 director for mental health who shall be responsible for ad13
ministration of this Act and ensuring the availability and
14 accessibility of high quality mental health services.
15 SEC. 302. OFFICE OF QUALITY CONTROL.
16 The Director shall appoint a director for an Office
17 of Quality Control. Such director shall, after consultation
18 with state and regional directors, provide annual rec19
ommendations to Congress, the President, the Secretary,
20 and other Program officials on how to ensure the highest
21 quality health care service delivery. The director of the Of22
fice of Quality Control shall conduct an annual review on
23 the adequacy of medically necessary services, and shall
24 make recommendations of any proposed changes to the
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1 Congress, the President, the Secretary, and other USNHC
2 Program officials.
3 SEC. 303. REGIONAL AND STATE ADMINISTRATION; EM4
PLOYMENT OF DISPLACED CLERICAL WORK5
ERS.
6 (a) ESTABLISHMENT OF USNHC PROGRAM RE7
GIONAL OFFICES.—The Secretary shall establish and
8 maintain USNHC regional offices for the purpose of dis9
tributing funds to providers of care. Whenever possible,
10 the Secretary should incorporate pre-existing Medicare in11
frastructure for this purpose.
12 (b) APPOINTMENT OF REGIONAL AND STATE DIREC13
TORS.—In each such regional office there shall be—
14 (1) one regional director appointed by the Di15
rector; and
16 (2) for each State in the region, a deputy direc17
tor (in this Act referred to as a ‘‘State Director’’)
18 appointed by the governor of that State.
19 (c) REGIONAL OFFICE DUTIES.—Regional offices of
20 the Program shall be responsible for—
21 (1) coordinating funding to health care pro22
viders and physicians; and
23 (2) coordinating billing and reimbursements
24 with physicians and health care providers through a
25 State-based reimbursement system.
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1 (d) STATE DIRECTOR’S DUTIES.—Each State Direc2
tor shall be responsible for the following duties:
3 (1) Providing an annual state health care needs
4 assessment report to the National Board of Uni5
versal Quality and Access, and the regional board,
6 after a thorough examination of health needs, in
7 consultation with public health officials, clinicians,
8 patients, and patient advocates.
9 (2) Health planning, including oversight of the
10 placement of new hospitals, clinics, and other health
11 care delivery facilities.
12 (3) Health planning, including oversight of the
13 purchase and placement of new health equipment to
14 ensure timely access to care and to avoid duplica15
tion.
16 (4) Submitting global budgets to the regional
17 director.
18 (5) Recommending changes in provider reim19
bursement or payment for delivery of health services
20 in the State.
21 (6) Establishing a quality assurance mechanism
22 in the State in order to minimize both under utiliza23
tion and over utilization and to assure that all pro24
viders meet high quality standards.
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1 (7) Reviewing program disbursements on a
2 quarterly basis and recommending needed adjust3
ments in fee schedules needed to achieve budgetary
4 targets and assure adequate access to needed care.
5 (e) FIRST PRIORITY IN RETRAINING AND JOB
6 PLACEMENT; 2 YEARS OF SALARY PARITY BENEFITS.—
7 The Program shall provide that clerical, administrative,
8 and billing personnel in insurance companies, doctors of9
fices, hospitals, nursing facilities, and other facilities
10 whose jobs are eliminated due to reduced administration—
11 (1) should have first priority in retraining and
12 job placement in the new system; and
13 (2) shall be eligible to receive two years of
14 USNHC employment transition benefits with each
15 year’s benefit equal to salary earned during the last
16 12 months of employment, but shall not exceed
17 $100,000 per year.
18 (f) ESTABLISHMENT OF USNHC EMPLOYMENT
19 TRANSITION FUND.—The Secretary shall establish a trust
20 fund from which expenditures shall be made to recipients
21 of the benefits allocated in subsection (e).
22 (g) ANNUAL APPROPRIATIONS TO USNHC EMPLOY23
MENT TRANSITION FUND.—Sums are authorized to be ap24
propriated annually as needed to fund the USNHC Em25
ployment Transition Benefits.
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1 (h) RETENTION OF RIGHT TO UNEMPLOYMENT BEN2
EFITS.—Nothing in this section shall be interpreted as a
3 waiver of USNHC Employment Transition benefit recipi4
ents’ right to receive Federal and State unemployment
5 benefits.
6 SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD
7 SYSTEM.
8 (a) IN GENERAL.—The Secretary shall create a
9 standardized, confidential electronic patient record system
10 in accordance with laws and regulations to maintain accu11
rate patient records and to simplify the billing process,
12 thereby reducing medical errors and bureaucracy.
13 (b) PATIENT OPTION.—Notwithstanding that all bill14
ing shall be preformed electronically, patients shall have
15 the option of keeping any portion of their medical records
16 separate from their electronic medical record.
17 SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND
18 ACCESS.
19 (a) ESTABLISHMENT.—
20 (1) IN GENERAL.—There is established a Na21
tional Board of Universal Quality and Access (in
22 this section referred to as the ‘‘Board’’) consisting
23 of 15 members appointed by the President, by and
24 with the advice and consent of the Senate.
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1 (2) QUALIFICATIONS.—The appointed members
2 of the Board shall include at least one of each of the
3 following:
4 (A) Health care professionals.
5 (B) Representatives of institutional pro6
viders of health care.
7 (C) Representatives of health care advo8
cacy groups.
9 (D) Representatives of labor unions.
10 (E) Citizen patient advocates.
11 (3) TERMS.—Each member shall be appointed
12 for a term of 6 years, except that the President shall
13 stagger the terms of members initially appointed so
14 that the term of no more than 3 members expires
15 in any year.
16 (4) PROHIBITION ON CONFLICTS OF INTER17
EST.—No member of the Board shall have a finan18
cial conflict of interest with the duties before the
19 Board.
20 (b) DUTIES.—
21 (1) IN GENERAL.—The Board shall meet at
22 least twice per year and shall advise the Secretary
23 and the Director on a regular basis to ensure qual24
ity, access, and affordability.
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1 (2) SPECIFIC ISSUES.—The Board shall specifi2
cally address the following issues:
3 (A) Access to care.
4 (B) Quality improvement.
5 (C) Efficiency of administration.
6 (D) Adequacy of budget and funding.
7 (E) Appropriateness of reimbursement lev8
els of physicians and other providers.
9 (F) Capital expenditure needs.
10 (G) Long-term care.
11 (H) Mental health and substance abuse
12 services.
13 (I) Staffing levels and working conditions
14 in health care delivery facilities.
15 (3) ESTABLISHMENT OF UNIVERSAL, BEST
16 QUALITY STANDARD OF CARE.—The Board shall
17 specifically establish a universal, best quality of
18 standard of care with respect to—
19 (A) appropriate staffing levels;
20 (B) appropriate medical technology;
21 (C) design and scope of work in the health
22 workplace;
23 (D) best practices; and
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1 (E) salary level and working conditions of
2 physicians, clinicians, nurses, other medical pro3
fessionals, and appropriate support staff.
4 (4) TWICE-A-YEAR REPORT.—The Board shall
5 report its recommendations twice each year to the
6 Secretary, the Director, Congress, and the Presi7
dent.
8 (c) COMPENSATION, ETC.—The following provisions
9 of section 1805 of the Social Security Act shall apply to
10 the Board in the same manner as they apply to the Medi11
care Payment Assessment Commission (except that any
12 reference to the Commission or the Comptroller General
13 shall be treated as references to the Board and the Sec14
retary, respectively):
15 (1) Subsection (c)(4) (relating to compensation
16 of Board members).
17 (2) Subsection (c)(5) (relating to chairman and
18 vice chairman).
19 (3) Subsection (c)(6) (relating to meetings).
20 (4) Subsection (d) (relating to director and
21 staff; experts and consultants).
22 (5) Subsection (e) (relating to powers).
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1 TITLE IV—ADDITIONAL
2 PROVISIONS
3 SEC. 401. TREATMENT OF VA AND IHS HEALTH PROGRAMS.
4 (a) VA HEALTH PROGRAMS.—This Act provides for
5 health programs of the Department of Veterans’ Affairs
6 to initially remain independent for the 10-year period that
7 begins on the date of the establishment of the USNHC
8 Program. After such 10-year period, the Congress shall
9 reevaluate whether such programs shall remain inde10
pendent or be integrated into the USNHC Program.
11 (b) INDIAN HEALTH SERVICE PROGRAMS.—This Act
12 provides for health programs of the Indian Health Service
13 to initially remain independent for the 5-year period that
14 begins on the date of the establishment of the USNHC
15 Program, after which such programs shall be integrated
16 into the USNHC Program.
17 SEC. 402. PUBLIC HEALTH AND PREVENTION.
18 It is the intent of this Act that the Program at all
19 times stress the importance of good public health through
20 the prevention of diseases.
21 SEC. 403. REDUCTION IN HEALTH DISPARITIES.
22 It is the intent of this Act to reduce health disparities
23 by race, ethnicity, income and geographic region, and to
24 provide high quality, cost-effective, culturally appropriate
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1 care to all individuals regardless of race, ethnicity, sexual
2 orientation, or language.
3 TITLE V—EFFECTIVE DATE
4 SEC. 501. EFFECTIVE DATE.
5 Except as otherwise specifically provided, this Act
6 shall take effect on the first day of the first year that be7
gins more than 1 year after the date of the enactment
8 of this Act, and shall apply to items and services furnished
9 on or after such date.
Æ
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111TH CONGRESS
1ST SESSION H. R. 676
To provide for comprehensive health insurance coverage for all United States
residents, improved health care delivery, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 26, 2009
Mr. CONYERS (for himself, Mr. KUCINICH, Ms. WATSON, Mr. ELLISON, Mr.
HINCHEY, Mr. DAVIS of Illinois, Ms. BALDWIN, Ms. LEE of California,
Mr. MASSA, Mr. NADLER of New York, Mr. MCDERMOTT, Mr. DOYLE,
Mr. GUTIERREZ, Mr. OLVER, Ms. KAPTUR, Ms. JACKSON-LEE of Texas,
Mr. ENGEL, Mr. MEEKS of New York, Ms. CLARKE, Mr. FARR, Mrs.
NAPOLITANO, Ms. PINGREE of Maine, Mr. TONKO, Ms. EDWARDS of
Maryland, Mr. GRIJALVA, Mr. BERMAN, Mr. DELAHUNT, Mr. CLAY, Ms.
KILPATRICK of Michigan, Ms. WOOLSEY, and Mr. COHEN) introduced the
following bill; which was referred to the Committee on Energy and Commerce,
and in addition to the Committees on Ways and Means and Natural
Resources, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the jurisdiction
of the committee concerned
A BILL
To provide for comprehensive health insurance coverage for
all United States residents, improved health care delivery,
and for other purposes.
1 Be it enacted by the Senate and House of Representa2
tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
2 (a) SHORT TITLE.—This Act may be cited as the
3 ‘‘United States National Health Care Act or the Ex4
panded and Improved Medicare for All Act’’.
5 (b) TABLE OF CONTENTS.—The table of contents of
6 this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions and terms.
TITLE I—ELIGIBILITY AND BENEFITS
Sec. 101. Eligibility and registration.
Sec. 102. Benefits and portability.
Sec. 103. Qualification of participating providers.
Sec. 104. Prohibition against duplicating coverage.
TITLE II—FINANCES
Subtitle A—Budgeting and Payments
Sec. 201. Budgeting process.
Sec. 202. Payment of providers and health care clinicians.
Sec. 203. Payment for long-term care.
Sec. 204. Mental health services.
Sec. 205. Payment for prescription medications, medical supplies, and medically
necessary assistive equipment.
Sec. 206. Consultation in establishing reimbursement levels.
Subtitle B—Funding
Sec. 211. Overview: funding the USNHC Program.
Sec. 212. Appropriations for existing programs.
TITLE III—ADMINISTRATION
Sec. 301. Public administration; appointment of Director.
Sec. 302. Office of Quality Control.
Sec. 303. Regional and State administration; employment of displaced clerical
workers.
Sec. 304. Confidential Electronic Patient Record System.
Sec. 305. National Board of Universal Quality and Access.
TITLE IV—ADDITIONAL PROVISIONS
Sec. 401. Treatment of VA and IHS health programs.
Sec. 402. Public health and prevention.
Sec. 403. Reduction in health disparities.
TITLE V—EFFECTIVE DATE
Sec. 501. Effective date.
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1 SEC. 2. DEFINITIONS AND TERMS.
2 In this Act:
3 (1) USNHC PROGRAM; PROGRAM.—The terms
4 ‘‘USNHC Program’’ and ‘‘Program’’ mean the pro5
gram of benefits provided under this Act and, unless
6 the context otherwise requires, the Secretary with
7 respect to functions relating to carrying out such
8 program.
9 (2) NATIONAL BOARD OF UNIVERSAL QUALITY
10 AND ACCESS.—The term ‘‘National Board of Uni11
versal Quality and Access’’ means such Board estab12
lished under section 305.
13 (3) REGIONAL OFFICE.—The term ‘‘regional of14
fice’’ means a regional office established under sec15
tion 303.
16 (4) SECRETARY.—The term ‘‘Secretary’’ means
17 the Secretary of Health and Human Services.
18 (5) DIRECTOR.—The term ‘‘Director’’ means,
19 in relation to the Program, the Director appointed
20 under section 301.
21 TITLE I—ELIGIBILITY AND
22 BENEFITS
23 SEC. 101. ELIGIBILITY AND REGISTRATION.
24 (a) IN GENERAL.—All individuals residing in the
25 United States (including any territory of the United
26 States) are covered under the USNHC Program entitling
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1 them to a universal, best quality standard of care. Each
2 such individual shall receive a card with a unique number
3 in the mail. An individual’s social security number shall
4 not be used for purposes of registration under this section.
5 (b) REGISTRATION.—Individuals and families shall
6 receive a United States National Health Insurance Card
7 in the mail, after filling out a United States National
8 Health Insurance application form at a health care pro9
vider. Such application form shall be no more than 2 pages
10 long.
11 (c) PRESUMPTION.—Individuals who present them12
selves for covered services from a participating provider
13 shall be presumed to be eligible for benefits under this Act,
14 but shall complete an application for benefits in order to
15 receive a United States National Health Insurance Card
16 and have payment made for such benefits.
17 (d) RESIDENCY CRITERIA.—The Secretary shall pro18
mulgate a rule that provides criteria for determining resi19
dency for eligibility purposes under the USNHC Program.
20 (e) COVERAGE FOR VISITORS.—The Secretary shall
21 promulgate a rule regarding visitors from other countries
22 who seek premeditated non-emergency surgical proce23
dures. Such a rule should facilitate the establishment of
24 country-to-country reimbursement arrangements or self
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1 pay arrangements between the visitor and the provider of
2 care.
3 SEC. 102. BENEFITS AND PORTABILITY.
4 (a) IN GENERAL.—The health care benefits under
5 this Act cover all medically necessary services, including
6 at least the following:
7 (1) Primary care and prevention.
8 (2) Inpatient care.
9 (3) Outpatient care.
10 (4) Emergency care.
11 (5) Prescription drugs.
12 (6) Durable medical equipment.
13 (7) Long-term care.
14 (8) Palliative care.
15 (9) Mental health services.
16 (10) The full scope of dental services (other
17 than cosmetic dentistry).
18 (11) Substance abuse treatment services.
19 (12) Chiropractic services.
20 (13) Basic vision care and vision correction
21 (other than laser vision correction for cosmetic pur22
poses).
23 (14) Hearing services, including coverage of
24 hearing aids.
25 (15) Podiatric care.
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1 (b) PORTABILITY.—Such benefits are available
2 through any licensed health care clinician anywhere in the
3 United States that is legally qualified to provide the bene4
fits.
5 (c) NO COST-SHARING.—No deductibles, copay6
ments, coinsurance, or other cost-sharing shall be imposed
7 with respect to covered benefits.
8 SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.
9 (a) REQUIREMENT TO BE PUBLIC OR NON-PROF10
IT.—
11 (1) IN GENERAL.—No institution may be a par12
ticipating provider unless it is a public or not-for13
profit institution. Private physicians, private clinics,
14 and private health care providers shall continue to
15 operate as private entities, but are prohibited from
16 being investor owned.
17 (2) CONVERSION OF INVESTOR-OWNED PRO18
VIDERS.—For-profit providers of care opting to par19
ticipate shall be required to convert to not-for-profit
20 status.
21 (3) PRIVATE DELIVERY OF CARE REQUIRE22
MENT.—For-profit providers of care that convert to
23 non-profit status shall remain privately owned and
24 operated entities.
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1 (4) COMPENSATION FOR CONVERSION.—The
2 owners of such for-profit providers shall be com3
pensated for reasonable financial losses incurred as
4 a result of the conversion from for-profit to non5
profit status.
6 (5) FUNDING.—There are authorized to be ap7
propriated from the Treasury such sums as are nec8
essary to compensate investor-owned providers as
9 provided for under paragraph (3).
10 (6) REQUIREMENTS.—The payments to owners
11 of converting for-profit providers shall occur during
12 a 15-year period, through the sale of U.S. Treasury
13 Bonds. Payment for conversions under paragraph
14 (3) shall not be made for loss of business profits.
15 (7) MECHANISM FOR CONVERSION PROCESS.—
16 The Secretary shall promulgate a rule to provide a
17 mechanism to further the timely, efficient, and fea18
sible conversion of for-profit providers of care.
19 (b) QUALITY STANDARDS.—
20 (1) IN GENERAL.—Health care delivery facili21
ties must meet State quality and licensing guidelines
22 as a condition of participation under such program,
23 including guidelines regarding safe staffing and
24 quality of care.
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1 (2) LICENSURE REQUIREMENTS.—Participating
2 clinicians must be licensed in their State of practice
3 and meet the quality standards for their area of
4 care. No clinician whose license is under suspension
5 or who is under disciplinary action in any State may
6 be a participating provider.
7 (c) PARTICIPATION OF HEALTH MAINTENANCE OR8
GANIZATIONS.—
9 (1) IN GENERAL.—Non-profit health mainte10
nance organizations that deliver care in their own
11 facilities and employ clinicians on a salaried basis
12 may participate in the program and receive global
13 budgets or capitation payments as specified in sec14
tion 202.
15 (2) EXCLUSION OF CERTAIN HEALTH MAINTE16
NANCE ORGANIZATIONS.—Other health maintenance
17 organizations, including those which principally con18
tract to pay for services delivered by non-employees,
19 shall be classified as insurance plans. Such organiza20
tions shall not be participating providers, and are
21 subject to the regulations promulgated by reason of
22 section 104(a) (relating to prohibition against dupli23
cating coverage).
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1 (d) FREEDOM OF CHOICE.—Patients shall have free
2 choice of participating physicians and other clinicians,
3 hospitals, and inpatient care facilities.
4 SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE.
5 (a) IN GENERAL.—It is unlawful for a private health
6 insurer to sell health insurance coverage that duplicates
7 the benefits provided under this Act.
8 (b) CONSTRUCTION.—Nothing in this Act shall be
9 construed as prohibiting the sale of health insurance cov10
erage for any additional benefits not covered by this Act,
11 such as for cosmetic surgery or other services and items
12 that are not medically necessary.
13 TITLE II—FINANCES
14 Subtitle A—Budgeting and
15 Payments
16 SEC. 201. BUDGETING PROCESS.
17 (a) ESTABLISHMENT OF OPERATING BUDGET AND
18 CAPITAL EXPENDITURES BUDGET.—
19 (1) IN GENERAL.—To carry out this Act there
20 are established on an annual basis consistent with
21 this title—
22 (A) an operating budget, including
23 amounts for optimal physician, nurse, and other
24 health care professional staffing;
25 (B) a capital expenditures budget;
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1 (C) reimbursement levels for providers con2
sistent with subtitle B; and
3 (D) a health professional education budget,
4 including amounts for the continued funding of
5 resident physician training programs.
6 (2) REGIONAL ALLOCATION.—After Congress
7 appropriates amounts for the annual budget for the
8 USNHC Program, the Director shall provide the re9
gional offices with an annual funding allotment to
10 cover the costs of each region’s expenditures. Such
11 allotment shall cover global budgets, reimbursements
12 to clinicians, health professional education, and cap13
ital expenditures. Regional offices may receive addi14
tional funds from the national program at the dis15
cretion of the Director.
16 (b) OPERATING BUDGET.—The operating budget
17 shall be used for—
18 (1) payment for services rendered by physicians
19 and other clinicians;
20 (2) global budgets for institutional providers;
21 (3) capitation payments for capitated groups;
22 and
23 (4) administration of the Program.
24 (c) CAPITAL EXPENDITURES BUDGET.—The capital
25 expenditures budget shall be used for funds needed for—
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1 (1) the construction or renovation of health fa2
cilities; and
3 (2) for major equipment purchases.
4 (d) PROHIBITION AGAINST CO-MINGLING OPER5
ATIONS AND CAPITAL IMPROVEMENT FUNDS.—It is pro6
hibited to use funds under this Act that are earmarked—
7 (1) for operations for capital expenditures; or
8 (2) for capital expenditures for operations.
9 SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLI10
NICIANS.
11 (a) ESTABLISHING GLOBAL BUDGETS; MONTHLY
12 LUMP SUM.—
13 (1) IN GENERAL.—The USNHC Program,
14 through its regional offices, shall pay each institu15
tional provider of care, including hospitals, nursing
16 homes, community or migrant health centers, home
17 care agencies, or other institutional providers or pre18
paid group practices, a monthly lump sum to cover
19 all operating expenses under a global budget.
20 (2) ESTABLISHMENT OF GLOBAL BUDGETS.—
21 The global budget of a provider shall be set through
22 negotiations between providers, State directors, and
23 regional directors, but are subject to the approval of
24 the Director. The budget shall be negotiated annu25
ally, based on past expenditures, projected changes
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1 in levels of services, wages and input, costs, a pro2
vider’s maximum capacity to provide care, and pro3
posed new and innovative programs.
4 (b) THREE PAYMENT OPTIONS FOR PHYSICIANS AND
5 CERTAIN OTHER HEALTH PROFESSIONALS.—
6 (1) IN GENERAL.—The Program shall pay phy7
sicians, dentists, doctors of osteopathy, pharmacists,
8 psychologists, chiropractors, doctors of optometry,
9 nurse practitioners, nurse midwives, physicians’ as10
sistants, and other advanced practice clinicians as li11
censed and regulated by the States by the following
12 payment methods:
13 (A) Fee for service payment under para14
graph (2).
15 (B) Salaried positions in institutions re16
ceiving global budgets under paragraph (3).
17 (C) Salaried positions within group prac18
tices or non-profit health maintenance organiza19
tions receiving capitation payments under para20
graph (4).
21 (2) FEE FOR SERVICE.—
22 (A) IN GENERAL.—The Program shall ne23
gotiate a simplified fee schedule that is fair and
24 optimal with representatives of physicians and
25 other clinicians, after close consultation with
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1 the National Board of Universal Quality and
2 Access and regional and State directors. Ini3
tially, the current prevailing fees or reimburse4
ment would be the basis for the fee negotiation
5 for all professional services covered under this
6 Act.
7 (B) CONSIDERATIONS.—In establishing
8 such schedule, the Director shall take into con9
sideration the following:
10 (i) The need for a uniform national
11 standard.
12 (ii) The goal of ensuring that physi13
cians, clinicians, pharmacists, and other
14 medical professionals be compensated at a
15 rate which reflects their expertise and the
16 value of their services, regardless of geo17
graphic region and past fee schedules.
18 (C) STATE PHYSICIAN PRACTICE REVIEW
19 BOARDS.—The State director for each State, in
20 consultation with representatives of the physi21
cian community of that State, shall establish
22 and appoint a physician practice review board
23 to assure quality, cost effectiveness, and fair re24
imbursements for physician delivered services.
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1 (D) FINAL GUIDELINES.—The Director
2 shall be responsible for promulgating final
3 guidelines to all providers.
4 (E) BILLING.—Under this Act physicians
5 shall submit bills to the regional director on a
6 simple form, or via computer. Interest shall be
7 paid to providers who are not reimbursed within
8 30 days of submission.
9 (F) NO BALANCE BILLING.—Licensed
10 health care clinicians who accept any payment
11 from the USNHC Program may not bill any
12 patient for any covered service.
13 (G) UNIFORM COMPUTER ELECTRONIC
14 BILLING SYSTEM.—The Director shall create a
15 uniform computerized electronic billing system,
16 including those areas of the United States
17 where electronic billing is not yet established.
18 (3) SALARIES WITHIN INSTITUTIONS RECEIVING
19 GLOBAL BUDGETS.—
20 (A) IN GENERAL.—In the case of an insti21
tution, such as a hospital, health center, group
22 practice, community and migrant health center,
23 or a home care agency that elects to be paid a
24 monthly global budget for the delivery of health
25 care as well as for education and prevention
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1 programs, physicians and other clinicians em2
ployed by such institutions shall be reimbursed
3 through a salary included as part of such a
4 budget.
5 (B) SALARY RANGES.—Salary ranges for
6 health care providers shall be determined in the
7 same way as fee schedules under paragraph (2).
8 (4) SALARIES WITHIN CAPITATED GROUPS.—
9 (A) IN GENERAL.—Health maintenance or10
ganizations, group practices, and other institu11
tions may elect to be paid capitation payments
12 to cover all outpatient, physician, and medical
13 home care provided to individuals enrolled to
14 receive benefits through the organization or en15
tity.
16 (B) SCOPE.—Such capitation may include
17 the costs of services of licensed physicians and
18 other licensed, independent practitioners pro19
vided to inpatients. Other costs of inpatient and
20 institutional care shall be excluded from capita21
tion payments, and shall be covered under insti22
tutions’ global budgets.
23 (C) PROHIBITION OF SELECTIVE ENROLL24
MENT.—Patients shall be permitted to enroll or
25 disenroll from such organizations or entities
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1 without discrimination and with appropriate no2
tice.
3 (D) HEALTH MAINTENANCE ORGANIZA4
TIONS.—Under this Act—
5 (i) health maintenance organizations
6 shall be required to reimburse physicians
7 based on a salary; and
8 (ii) financial incentives between such
9 organizations and physicians based on uti10
lization are prohibited.
11 SEC. 203. PAYMENT FOR LONG-TERM CARE.
12 (a) ALLOTMENT FOR REGIONS.—The Program shall
13 provide for each region a single budgetary allotment to
14 cover a full array of long-term care services under this
15 Act.
16 (b) REGIONAL BUDGETS.—Each region shall provide
17 a global budget to local long-term care providers for the
18 full range of needed services, including in-home, nursing
19 home, and community based care.
20 (c) BASIS FOR BUDGETS.—Budgets for long-term
21 care services under this section shall be based on past ex22
penditures, financial and clinical performance, utilization,
23 and projected changes in service, wages, and other related
24 factors.
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1 (d) FAVORING NON-INSTITUTIONAL CARE.—All ef2
forts shall be made under this Act to provide long-term
3 care in a home- or community-based setting, as opposed
4 to institutional care.
5 SEC. 204. MENTAL HEALTH SERVICES.
6 (a) IN GENERAL.—The Program shall provide cov7
erage for all medically necessary mental health care on
8 the same basis as the coverage for other conditions. Li9
censed mental health clinicians shall be paid in the same
10 manner as specified for other health professionals, as pro11
vided for in section 202(b).
12 (b) FAVORING COMMUNITY-BASED CARE.—The
13 USNHC Program shall cover supportive residences, occu14
pational therapy, and ongoing mental health and coun15
seling services outside the hospital for patients with seri16
ous mental illness. In all cases the highest quality and
17 most effective care shall be delivered, and, for some indi18
viduals, this may mean institutional care.
19 SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS,
20 MEDICAL SUPPLIES, AND MEDICALLY NEC21
ESSARY ASSISTIVE EQUIPMENT.
22 (a) NEGOTIATED PRICES.—The prices to be paid
23 each year under this Act for covered pharmaceuticals,
24 medical supplies, and medically necessary assistive equip25
ment shall be negotiated annually by the Program.
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1 (b) PRESCRIPTION DRUG FORMULARY.—
2 (1) IN GENERAL.—The Program shall establish
3 a prescription drug formulary system, which shall
4 encourage best-practices in prescribing and discour5
age the use of ineffective, dangerous, or excessively
6 costly medications when better alternatives are avail7
able.
8 (2) PROMOTION OF USE OF GENERICS.—The
9 formulary shall promote the use of generic medica10
tions but allow the use of brand-name and off-for11
mulary medications.
12 (3) FORMULARY UPDATES AND PETITION
13 RIGHTS.—The formulary shall be updated frequently
14 and clinicians and patients may petition their region
15 or the Director to add new pharmaceuticals or to re16
move ineffective or dangerous medications from the
17 formulary.
18 SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSE19
MENT LEVELS.
20 Reimbursement levels under this subtitle shall be set
21 after close consultation with regional and State Directors
22 and after the annual meeting of National Board of Uni23
versal Quality and Access.
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1 Subtitle B—Funding
2 SEC. 211. OVERVIEW: FUNDING THE USNHC PROGRAM.
3 (a) IN GENERAL.—The USNHC Program is to be
4 funded as provided in subsection (c)(1).
5 (b) USNHC TRUST FUND.—There shall be estab6
lished a USNHC Trust Fund in which funds provided
7 under this section are deposited and from which expendi8
tures under this Act are made.
9 (c) FUNDING.—
10 (1) IN GENERAL.—There are appropriated to
11 the USNHC Trust Fund amounts sufficient to carry
12 out this Act from the following sources:
13 (A) Existing sources of Federal Govern14
ment revenues for health care.
15 (B) Increasing personal income taxes on
16 the top 5 percent income earners.
17 (C) Instituting a modest and progressive
18 excise tax on payroll and self-employment in19
come.
20 (D) Instituting a small tax on stock and
21 bond transactions.
22 (2) SYSTEM SAVINGS AS A SOURCE OF FINANC23
ING.—Funding otherwise required for the Program
24 is reduced as a result of—
25 (A) vastly reducing paperwork;
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1 (B) requiring a rational bulk procurement
2 of medications under section 205(a); and
3 (C) improved access to preventive health
4 care.
5 (3) ADDITIONAL ANNUAL APPROPRIATIONS TO
6 USNHC PROGRAM.—Additional sums are authorized
7 to be appropriated annually as needed to maintain
8 maximum quality, efficiency, and access under the
9 Program.
10 SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS.
11 Notwithstanding any other provision of law, there are
12 hereby transferred and appropriated to carry out this Act,
13 amounts from the Treasury equivalent to the amounts the
14 Secretary estimates would have been appropriated and ex15
pended for Federal public health care programs, including
16 funds that would have been appropriated under the Medi17
care program under title XVIII of the Social Security Act,
18 under the Medicaid program under title XIX of such Act,
19 and under the Children’s Health Insurance Program
20 under title XXI of such Act.
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1 TITLE III—ADMINISTRATION
2 SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DI3
RECTOR.
4 (a) IN GENERAL.—Except as otherwise specifically
5 provided, this Act shall be administered by the Secretary
6 through a Director appointed by the Secretary.
7 (b) LONG-TERM CARE.—The Director shall appoint
8 a director for long-term care who shall be responsible for
9 administration of this Act and ensuring the availability
10 and accessibility of high quality long-term care services.
11 (c) MENTAL HEALTH.—The Director shall appoint a
12 director for mental health who shall be responsible for ad13
ministration of this Act and ensuring the availability and
14 accessibility of high quality mental health services.
15 SEC. 302. OFFICE OF QUALITY CONTROL.
16 The Director shall appoint a director for an Office
17 of Quality Control. Such director shall, after consultation
18 with state and regional directors, provide annual rec19
ommendations to Congress, the President, the Secretary,
20 and other Program officials on how to ensure the highest
21 quality health care service delivery. The director of the Of22
fice of Quality Control shall conduct an annual review on
23 the adequacy of medically necessary services, and shall
24 make recommendations of any proposed changes to the
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1 Congress, the President, the Secretary, and other USNHC
2 Program officials.
3 SEC. 303. REGIONAL AND STATE ADMINISTRATION; EM4
PLOYMENT OF DISPLACED CLERICAL WORK5
ERS.
6 (a) ESTABLISHMENT OF USNHC PROGRAM RE7
GIONAL OFFICES.—The Secretary shall establish and
8 maintain USNHC regional offices for the purpose of dis9
tributing funds to providers of care. Whenever possible,
10 the Secretary should incorporate pre-existing Medicare in11
frastructure for this purpose.
12 (b) APPOINTMENT OF REGIONAL AND STATE DIREC13
TORS.—In each such regional office there shall be—
14 (1) one regional director appointed by the Di15
rector; and
16 (2) for each State in the region, a deputy direc17
tor (in this Act referred to as a ‘‘State Director’’)
18 appointed by the governor of that State.
19 (c) REGIONAL OFFICE DUTIES.—Regional offices of
20 the Program shall be responsible for—
21 (1) coordinating funding to health care pro22
viders and physicians; and
23 (2) coordinating billing and reimbursements
24 with physicians and health care providers through a
25 State-based reimbursement system.
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1 (d) STATE DIRECTOR’S DUTIES.—Each State Direc2
tor shall be responsible for the following duties:
3 (1) Providing an annual state health care needs
4 assessment report to the National Board of Uni5
versal Quality and Access, and the regional board,
6 after a thorough examination of health needs, in
7 consultation with public health officials, clinicians,
8 patients, and patient advocates.
9 (2) Health planning, including oversight of the
10 placement of new hospitals, clinics, and other health
11 care delivery facilities.
12 (3) Health planning, including oversight of the
13 purchase and placement of new health equipment to
14 ensure timely access to care and to avoid duplica15
tion.
16 (4) Submitting global budgets to the regional
17 director.
18 (5) Recommending changes in provider reim19
bursement or payment for delivery of health services
20 in the State.
21 (6) Establishing a quality assurance mechanism
22 in the State in order to minimize both under utiliza23
tion and over utilization and to assure that all pro24
viders meet high quality standards.
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1 (7) Reviewing program disbursements on a
2 quarterly basis and recommending needed adjust3
ments in fee schedules needed to achieve budgetary
4 targets and assure adequate access to needed care.
5 (e) FIRST PRIORITY IN RETRAINING AND JOB
6 PLACEMENT; 2 YEARS OF SALARY PARITY BENEFITS.—
7 The Program shall provide that clerical, administrative,
8 and billing personnel in insurance companies, doctors of9
fices, hospitals, nursing facilities, and other facilities
10 whose jobs are eliminated due to reduced administration—
11 (1) should have first priority in retraining and
12 job placement in the new system; and
13 (2) shall be eligible to receive two years of
14 USNHC employment transition benefits with each
15 year’s benefit equal to salary earned during the last
16 12 months of employment, but shall not exceed
17 $100,000 per year.
18 (f) ESTABLISHMENT OF USNHC EMPLOYMENT
19 TRANSITION FUND.—The Secretary shall establish a trust
20 fund from which expenditures shall be made to recipients
21 of the benefits allocated in subsection (e).
22 (g) ANNUAL APPROPRIATIONS TO USNHC EMPLOY23
MENT TRANSITION FUND.—Sums are authorized to be ap24
propriated annually as needed to fund the USNHC Em25
ployment Transition Benefits.
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•HR 676 IH
1 (h) RETENTION OF RIGHT TO UNEMPLOYMENT BEN2
EFITS.—Nothing in this section shall be interpreted as a
3 waiver of USNHC Employment Transition benefit recipi4
ents’ right to receive Federal and State unemployment
5 benefits.
6 SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD
7 SYSTEM.
8 (a) IN GENERAL.—The Secretary shall create a
9 standardized, confidential electronic patient record system
10 in accordance with laws and regulations to maintain accu11
rate patient records and to simplify the billing process,
12 thereby reducing medical errors and bureaucracy.
13 (b) PATIENT OPTION.—Notwithstanding that all bill14
ing shall be preformed electronically, patients shall have
15 the option of keeping any portion of their medical records
16 separate from their electronic medical record.
17 SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND
18 ACCESS.
19 (a) ESTABLISHMENT.—
20 (1) IN GENERAL.—There is established a Na21
tional Board of Universal Quality and Access (in
22 this section referred to as the ‘‘Board’’) consisting
23 of 15 members appointed by the President, by and
24 with the advice and consent of the Senate.
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1 (2) QUALIFICATIONS.—The appointed members
2 of the Board shall include at least one of each of the
3 following:
4 (A) Health care professionals.
5 (B) Representatives of institutional pro6
viders of health care.
7 (C) Representatives of health care advo8
cacy groups.
9 (D) Representatives of labor unions.
10 (E) Citizen patient advocates.
11 (3) TERMS.—Each member shall be appointed
12 for a term of 6 years, except that the President shall
13 stagger the terms of members initially appointed so
14 that the term of no more than 3 members expires
15 in any year.
16 (4) PROHIBITION ON CONFLICTS OF INTER17
EST.—No member of the Board shall have a finan18
cial conflict of interest with the duties before the
19 Board.
20 (b) DUTIES.—
21 (1) IN GENERAL.—The Board shall meet at
22 least twice per year and shall advise the Secretary
23 and the Director on a regular basis to ensure qual24
ity, access, and affordability.
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1 (2) SPECIFIC ISSUES.—The Board shall specifi2
cally address the following issues:
3 (A) Access to care.
4 (B) Quality improvement.
5 (C) Efficiency of administration.
6 (D) Adequacy of budget and funding.
7 (E) Appropriateness of reimbursement lev8
els of physicians and other providers.
9 (F) Capital expenditure needs.
10 (G) Long-term care.
11 (H) Mental health and substance abuse
12 services.
13 (I) Staffing levels and working conditions
14 in health care delivery facilities.
15 (3) ESTABLISHMENT OF UNIVERSAL, BEST
16 QUALITY STANDARD OF CARE.—The Board shall
17 specifically establish a universal, best quality of
18 standard of care with respect to—
19 (A) appropriate staffing levels;
20 (B) appropriate medical technology;
21 (C) design and scope of work in the health
22 workplace;
23 (D) best practices; and
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1 (E) salary level and working conditions of
2 physicians, clinicians, nurses, other medical pro3
fessionals, and appropriate support staff.
4 (4) TWICE-A-YEAR REPORT.—The Board shall
5 report its recommendations twice each year to the
6 Secretary, the Director, Congress, and the Presi7
dent.
8 (c) COMPENSATION, ETC.—The following provisions
9 of section 1805 of the Social Security Act shall apply to
10 the Board in the same manner as they apply to the Medi11
care Payment Assessment Commission (except that any
12 reference to the Commission or the Comptroller General
13 shall be treated as references to the Board and the Sec14
retary, respectively):
15 (1) Subsection (c)(4) (relating to compensation
16 of Board members).
17 (2) Subsection (c)(5) (relating to chairman and
18 vice chairman).
19 (3) Subsection (c)(6) (relating to meetings).
20 (4) Subsection (d) (relating to director and
21 staff; experts and consultants).
22 (5) Subsection (e) (relating to powers).
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1 TITLE IV—ADDITIONAL
2 PROVISIONS
3 SEC. 401. TREATMENT OF VA AND IHS HEALTH PROGRAMS.
4 (a) VA HEALTH PROGRAMS.—This Act provides for
5 health programs of the Department of Veterans’ Affairs
6 to initially remain independent for the 10-year period that
7 begins on the date of the establishment of the USNHC
8 Program. After such 10-year period, the Congress shall
9 reevaluate whether such programs shall remain inde10
pendent or be integrated into the USNHC Program.
11 (b) INDIAN HEALTH SERVICE PROGRAMS.—This Act
12 provides for health programs of the Indian Health Service
13 to initially remain independent for the 5-year period that
14 begins on the date of the establishment of the USNHC
15 Program, after which such programs shall be integrated
16 into the USNHC Program.
17 SEC. 402. PUBLIC HEALTH AND PREVENTION.
18 It is the intent of this Act that the Program at all
19 times stress the importance of good public health through
20 the prevention of diseases.
21 SEC. 403. REDUCTION IN HEALTH DISPARITIES.
22 It is the intent of this Act to reduce health disparities
23 by race, ethnicity, income and geographic region, and to
24 provide high quality, cost-effective, culturally appropriate
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1 care to all individuals regardless of race, ethnicity, sexual
2 orientation, or language.
3 TITLE V—EFFECTIVE DATE
4 SEC. 501. EFFECTIVE DATE.
5 Except as otherwise specifically provided, this Act
6 shall take effect on the first day of the first year that be7
gins more than 1 year after the date of the enactment
8 of this Act, and shall apply to items and services furnished
9 on or after such date.
Æ
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