[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3080 Introduced in House (IH)]







107th CONGRESS
  1st Session
                                H. R. 3080

  To establish a United States Health Service to provide high quality 
    comprehensive health care for all Americans and to overcome the 
      deficiencies in the present system of health care delivery.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 10, 2001

   Ms. Lee introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
  Education and the Workforce, and Ways and Means, 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 establish a United States Health Service to provide high quality 
    comprehensive health care for all Americans and to overcome the 
      deficiencies in the present system of health care delivery.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Josephine Butler 
United States Health Service Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Purposes.
Sec. 4. Definitions.
   TITLE I--ESTABLISHMENT AND OPERATION OF THE UNITED STATES HEALTH 
                                SERVICE

Sec. 101. Establishment of the Service.
Sec. 102. Appointment of the National Health Board.
Sec. 103. Powers and duties of the National Health Board.
Sec. 104. Representation in local and regional authorities.
Sec. 105. Public accountability and financial disclosure.
Sec. 106. Inspector General.
Sec. 107. Establishment of health care delivery regions.
      TITLE II--DELIVERY OF HEALTH CARE AND SUPPLEMENTAL SERVICES

          Subtitle A--Patients' Rights in Health Care Delivery

Sec. 201. Basic health rights.
Sec. 202. Right to paid leave to receive health care services.
Subtitle B--Eligibility for, Nature of, and Scope of Services Provided 
                             by the Service

Sec. 211. Eligibility for services.
Sec. 212. Entitlement to services.
Sec. 213. Provision of health care and supplemental services.
Subtitle C--Health Care Facilities and Delivery of Health Care Services

Sec. 221. Establishment of health care facilities and distribution of 
                            delivery of health care and other services.
Sec. 222. Operation and inspection of health care facilities.
Sec. 223. Provision of health services relating to reproduction and 
                            childbearing.
                     TITLE III--HEALTH LABOR FORCE

              Subtitle A--Job Categories and Certification

Sec. 301. Effect of State law.
Sec. 302. Qualifications of health workers.
Sec. 303. Establishment of job categories and certification standards.
                Subtitle B--Education of Health Workers

Sec. 311. Health team schools.
Sec. 312. Service requirement.
Sec. 313. Payment for certain educational loans.
   Subtitle C--Employment and Labor-Management Relations Within the 
                                Service

Sec. 321. Employment, transfer, promotion, and receipt of fees.
Sec. 322. Applicability of laws relating to Federal employees.
Sec. 323. Applicability of Federal labor-management relations laws.
Sec. 324. Defense of certain malpractice and negligence suits.
               TITLE IV--OTHER FUNCTIONS OF HEALTH BOARDS

      Subtitle A--Advocacy, Grievance Procedures, and Trusteeships

Sec. 401. Advocacy and legal services program.
Sec. 402. Grievance procedures.
          Subtitle B--Occupational Safety and Health Programs

Sec. 411. Functions of the National Health Board.
Sec. 412. Community occupational safety and health activities.
Sec. 413. Workplace health facilities.
Sec. 414. Employee rights relating to occupational safety and health.
Sec. 415. Definitions.
     Subtitle C--Health and Health Care Delivery Research, Quality 
                      Assurance, and Health Equity

Sec. 421. Principles and guidelines for research.
Sec. 422. Establishment of institutes.
 Subtitle D--Health Planning, Distribution of Drugs and Other Medical 
                 Supplies, and Miscellaneous Functions

Sec. 431. Health planning and budgeting.
Sec. 432. Distribution of drugs and other medical supplies.
Sec. 433. Miscellaneous functions of the National Health Board.
                   TITLE V--FINANCING OF THE SERVICE

                    Subtitle A--Health Service Taxes

Sec. 501. Individual and corporate income taxes.
Sec. 502. Other changes in the Internal Revenue Code of 1986.
Sec. 503. Existing employer-employee health benefit plans.
Sec. 504. Workers compensation programs.
                 Subtitle B--Health Service Trust Fund

Sec. 511. Establishment of health service trust fund.
Sec. 512. Transfer of funds to the health service trust fund.
Sec. 513. Administration of health service trust fund.
              Subtitle C--Preparation of Plans and Budgets

Sec. 521. Determination of fund availability.
Sec. 522. Preparation of regional budgets.
            Subtitle D--Allocation and Distribution of Funds

Sec. 531. National budget.
Sec. 532. Special operating expense fund.
Sec. 533. Distribution of funds.
Sec. 534. Annual statement, records, and audits.
                     Subtitle E--General Provisions

Sec. 541. Issuance of obligations.
Sec. 542. Definitions.
                   TITLE VI--MISCELLANEOUS PROVISIONS

Sec. 601. Effective date of health services.
Sec. 602. Repeal of provisions.
Sec. 603. Transition provisions.
Sec. 604. Amendment to Budget and Accounting Act.
Sec. 605. Separability.

SEC. 2. FINDINGS.

    The Congress makes the following findings:
            (1) The health of the Nation's people is a foundation of 
        their well-being.
            (2) High quality health care is a right of all people.
            (3) Many of the Nation's people are unable fully to 
        exercise this right because of the inability of the present 
        health care delivery system to make high quality health care 
        available to all individuals regardless of race, sex, age, 
        national origin, income, marital status, sexual orientation, 
        religion, political belief, place of residence, employment 
        status, or previous health status.
            (4) The present health care system has failed to provide 
        financial coverage for health care services for more than forty 
        million Americans, and the percent lacking such coverage grows 
        each year.
            (5) The present health care system has failed to provide 
        for sufficient effective preventive measures that would address 
        the deterioration in occupational, environmental, and social 
        conditions affecting the health of the people of this Nation.
            (6) Unnecessary and excessive profits and administrative 
        expenses have inflated the cost of health care.
            (7) The growth of for profit medical care and for profit 
        managed care is making it difficult for health care personnel 
        to provide, and users to receive, the full range of health 
        services they believe to be necessary, appropriate, and 
        desirable.
            (8) The health professions have failed to control the cost 
        of their services and the imbalance in the number of health 
        workers among geographic areas or health care specialties.
            (9) The present health care system has failed to make full 
        and efficient use of allied health workers.
            (10) A United States Health Service is the best means to 
        implement the right to high quality health care and to overcome 
        the deficiencies in the present health care delivery system.

SEC. 3. PURPOSES.

    The purposes of this Act are as follows:
            (1) To create a United States Health Service to provide 
        without charge to all residents, regardless of race, sex, age, 
        national origin, income, marital status, sexual orientation, 
        religion, political belief, place of residence, employment 
        status, or previous health status, comprehensive health care 
        services delivered by salaried health workers and emphasizing 
        the promotion and maintenance of health as well as the 
        treatment of illness.
            (2) To establish representative and democratic governance 
        of the Service.
            (3) To provide health workers in the Service with fair and 
        reasonable compensation, secure employment, opportunities for 
        full and equal participation in the governance of health 
        facilities, and opportunities for advancement without regard to 
        race, sex, age, national origin, sexual orientation, religion, 
        or political belief.
            (4) To increase the availability and continuity of health 
        care by linking local health care facilities to hospitals and 
        specialized care facilities.
            (5) To overcome present disparities in health and access to 
        health care resources, especially for currently underserved 
        innercity and rural populations, minority groups, prisoners, 
        and occupational groups, by redistributing health care 
        resources to underserved populations, and by enhancing public 
        health and preventive health services.
            (6) To finance the Service through progressive taxation of 
        individuals and employer contributions, and to distribute these 
        revenues on a capitation basis, supplemented by allocations to 
        meet special health care needs.

SEC. 4. DEFINITIONS.

    For the purposes of this Act, unless the context implies otherwise:
            (1) Health care facility.--The term ``health care 
        facility'' means an administrative unit composed of specified 
        staff, equipment, and premises and established by a health 
        board as an appropriate unit of organization for the delivery 
        of specified health care or supplemental services under this 
        Act.
            (2) Health worker.--The term ``health worker'' includes--
                    (A) any employee of the Service; and
                    (B) any individual who for remuneration delivers, 
                administers any program in, provides supporting 
                services for, teaches the subject matter of, or 
                performs research in, health care services.
            (3) Indirect provider of health care.--The term ``indirect 
        provider of health care'' means an individual who--
                    (A) receives (either directly or through his or her 
                spouse) more than \1/10\ of his or her gross annual 
                income from any one or combination of--
                            (i) fees or other compensation for 
                        provision of, research into, or instruction in, 
                        the provision of health care,
                            (ii) entities engaged in the provision of 
                        health care or in such research or instruction,
                            (iii) producing or supplying drugs, medical 
                        equipment, or other articles for individuals or 
                        entities for use in the provision of or in 
                        research into or instruction in the provision 
                        of health care, or
                            (iv) entities engaged in producing drugs, 
                        medical equipment, or such other articles;
                    (B) holds a fiduciary position with, or has a 
                fiduciary interest in, any entity described in clause 
                (ii) or (iv) of subparagraph (A); or
                    (C) is engaged in issuing any policy or contract of 
                individual or group health insurance or hospital or 
                medical service benefits.
            (4) National health board.--The term ``National Health 
        Board'' means the National Health Board of the Service.
            (5) Service.--The term ``Service'' means the United States 
        Health Service established in section 101.
            (6) Service-related terms.--
                    (A) Health care services.--The term ``health care 
                services'' means the services described in paragraphs 
                (1) through (5) of section 213(a).
                    (B) Supplemental services.--The term ``supplemental 
                services'' means the services described in paragraphs 
                (1), (2), and (3) of section 213(b).
            (7) User.--The term ``user'' means an individual who is 
        eligible under section 211 to receive health care services from 
        the Service under this Act.

   TITLE I--ESTABLISHMENT AND OPERATION OF THE UNITED STATES HEALTH 
                                SERVICE

SEC. 101. ESTABLISHMENT OF THE SERVICE.

    (a) In General.--There is established, as an independent 
establishment of the executive branch of the United States, the United 
States Health Service.
    (b) Authority.--
            (1) National health board.--The authority of the Service 
        shall be exercised by the National Health Board and, in 
        accordance with this Act and guidelines established by such 
        Board, by local and regional authorities affiliated with the 
        Board.
            (2) Eminent domain authority.--The Service shall have the 
        authority, under the power of eminent domain, to acquire by 
        condemnation under judicial process real estate for the Service 
        for public purposes whenever it is necessary or advantageous to 
        do so.
    (c) Administration.--The Board shall implement administrative 
measures as necessary to assure the equitable distribution and 
allocation of health care resources and services.
    (d) Accountability and Control.--The Board shall establish 
mechanisms to assure accountable, representative and democratic 
governance of the Service and of health care facilities by health care 
users and workers, with limits on conflicts of interest as described in 
this Act.

SEC. 102. APPOINTMENT OF THE NATIONAL HEALTH BOARD.

    The President shall, no later than 30 days after the date of the 
enactment of this Act, appoint 21 individuals--
            (1) who are 18 years of age or older;
            (2) who are concerned about the health care problems of the 
        Nation;
            (3) who approximate the Nation's population by race, sex, 
        income, language, and region of residence, and approximate the 
        percentage of rural and frontier populations; and
            (4) no more than seven of whom are or have been health 
        workers, indirect providers of health care, or members of the 
        immediate family of such workers or indirect providers within 
        24 months of the date of such nomination, to serve as members 
        of the National Health Board of the Service.

SEC. 103. POWERS AND DUTIES OF THE NATIONAL HEALTH BOARD.

    The National Health Board shall--
            (1) establish the boundaries of health care delivery 
        regions, in accordance with section 107;
            (2) establish procedures for creating local and regional 
        authorities within each health care delivery region, to oversee 
        and administer the delivery of health services, pursuant to 
        section 104, and other provisions of this Act in their 
        respective regions and local areas;
            (3) carry out such duties of the National Health Board as 
        it deems necessary and consistent with the timetable given 
        under this Act and the purposes of the Service; and
            (4) provide for the recording of minutes of each of its 
        meetings, and shall make such records available to the public 
        for inspection and copying.

SEC. 104. REPRESENTATION IN LOCAL AND REGIONAL AUTHORITIES.

    The governing bodies of the local and regional authorities created 
pursuant to section 103(b) shall consist of representatives of users 
resident in their local area or region and representatives of health 
workers employed by the Service in their local area or region. 
Representatives of such users shall comprise the majority of such 
representatives and representatives of such health workers shall 
comprise a minority.

SEC. 105. PUBLIC ACCOUNTABILITY AND FINANCIAL DISCLOSURE.

    (a) Prohibition of Conflicts of Interest.--
            (1) In general.--Individuals with direct or indirect 
        conflicts of interest shall not serve on health boards or 
        authorities. Subject to paragraph (2), such conflicts may 
        consist of ownership of, employment in, or other financial 
        affiliation with any industry in a position to profit or 
        otherwise benefit from the activities of the health board.
            (2) Exception.--Paragraph (1) shall not apply to employment 
        as a health worker by the Service as specified in this Act.
    (b) Disclosure.--Candidates for health boards or authorities shall 
fully disclose any such potential conflicts of interest, and if elected 
or appointed shall sever any affiliations that could result in a 
conflict.

SEC. 106. INSPECTOR GENERAL FOR HEALTH SERVICES.

    Within the United States Health Service there shall be an Office of 
the Inspector General for Health Services, to be headed by an Inspector 
General for Health Services, that shall have authority to ensure the 
effective operation of the services pursuant to this Act and to 
investigate and pursue any grievances against the National Health Board 
or its local authorities. The Inspector General shall have the same 
authority as an Inspector General has under the Inspector General Act 
of 1978.

SEC. 107. ESTABLISHMENT OF HEALTH CARE DELIVERY REGIONS.

    (a) Establishment of Health Care Delivery Regions.--No later than 6 
months after the appointment of members of the National Health Board, 
such Board shall establish, in accordance with this section, health 
care delivery regions throughout the United States.
    (b) Requirements for Delivery Regions.--Each health care delivery 
region shall meet the following requirements:
            (1) The region shall be a contiguous geographic area 
        appropriate for the effective governance, planning, and 
        delivery of all health care and supplemental services under 
        this Act for residents of the region.
            (2) The region shall have a population of not less than 
        500,000 and of not more than 3,000,000 individuals, except 
        that--
                    (A) the population of a region may be more than 
                3,000,000 if the region includes a standard 
                metropolitan statistical area (as determined by the 
                Office of Management and Budget) with a population of 
                more than 3,000,000; and
                    (B) the population of a region may be less than 
                500,000 if the National Health Board determines that 
                this is necessary to facilitate the delivery of health 
                care and supplemental services or the effective 
                governance of the health program within such region.
        A region under subparagraph (B) may be a sparsely populated 
        frontier area which consists of a very large or multi-state 
        geographic area.
            (3) The boundaries of each region shall take into account--
                    (A) any economic or geographic barrier to the 
                receipt of health care and supplemental services in 
                nonmetropolitan areas, and
                    (B) the differences in needs between 
                nonmetropolitan and metropolitan areas in the planning, 
                development, and delivery of health care and 
                supplemental services.
    (c) Modification of Boundaries.--The National Health Board shall 
review the boundaries of regions no later than 2 years after each 
decennial national census, or upon receipt of and at such other times 
as it deems necessary, and may modify the boundary of any region in 
which there has been a substantial shift of population justifying such 
modification or if such modification would better carry out the 
purposes of this Act, and if such modification is approved in a 
referendum of residents in an area whose regional identification would 
be changed by making such modification.
    (d) Process.--At least 60 days prior to the establishment of the 
boundaries of any region, or modification of the boundaries, the 
National Health Board shall collaborate with its regional authorities 
to provide for--
            (1) notice in the area which would be affected by the 
        establishment of such boundaries of the boundaries proposed to 
        be established, and of the date, time, and location of the 
        public hearing on such establishment as provided in paragraph 
        (2); and
            (2) a public hearing at which individuals can speak or 
        present written statements relating to the establishment of 
        such boundaries.

      TITLE II--DELIVERY OF HEALTH CARE AND SUPPLEMENTAL SERVICES

          Subtitle A--Patients' Rights in Health Care Delivery

SEC. 201. BASIC HEALTH RIGHTS.

    The Service, in its delivery of health care services to users, 
shall ensure that every such individual is given the following basic 
health rights:
            (1) The right to receive high quality health care and 
        supplemental services from any facility within the Service 
        capable of providing such services without charge and without 
        discrimination on account of race, sex, age, religion, 
        language, income, marital status, sexual orientation, dress, or 
        previous health status.
            (2) The right to humane, respectful, dignified, and 
        comforting health care, and to the reduction of pain and 
        distressful symptoms.
            (3) The right to have all medically necessary or 
        appropriate health services delivered in a convenient and 
        timely manner. Any decision to deny or postpone such necessary 
        or appropriate care shall be made only on the basis of 
        temporary and reasonable limitations in the availability of 
        service personnel and physical facilities. Users shall have the 
        opportunity for timely and effective appeal of any decision to 
        deny or postpone care.
            (4) The right to choose the health workers who shall be 
        responsible for, and the health facilities in which to receive, 
        the individual's health care services.
            (5) The right of access to all information, including the 
        individual's health records and the medical dictionary produced 
        under section 433(b), which promotes an understanding of 
        health.
            (6) The right to have all health care information, reports, 
        and educational materials translated into the individual's 
        primary language.
            (7) The right to receive, prior to the delivery of any 
        health care service, a careful, prompt, and intelligible--
                    (A) explanation of the indications, diagnoses, 
                benefits, side effects, and risks involved in the 
                delivery of such service, and a description of all 
                medically necessary or appropriate alternatives to such 
                service (including no treatment);
                    (B) answer to any question relating to such health 
                care service; and
                    (C) explanation of one's health rights described in 
                this subtitle, and the right to have such health care 
                service delivered only with the individual's prior, 
                voluntary, written consent.
            (8) The right to refuse the initial or continuing delivery 
        of any health care service whenever such refusal does not 
        directly endanger the public health or, in accordance with 
        State law, the health of the individual if the individual is 
        dangerous to himself or herself.
            (9) The right to have all individually identifiable 
        information and documents treated confidentially and not 
        disclosed (except for statistical purposes and for the control 
        of communicable diseases, drug abuse, and child abuse) without 
        the individual's prior, voluntary, and written consent.
            (10) The right of access at all times to individuals or 
        groups for counseling, health information, and assistance on 
        health matters, including access to user advocates who shall--
                    (A) assist users in choosing the most appropriate 
                sites from which to receive health services and the 
                most appropriate health workers from whom to receive 
                such services;
                    (B) provide counseling and assistance to users in 
                filing complaints; and
                    (C) investigate instances of poor quality services 
                or improper treatment of users and bring such instances 
                to the attention of the applicable authority.
            (11) The right to be accompanied and visited at any time by 
        a friend, relative, or independent advocate of the individual's 
        choosing, and the right to have routine services, such as 
        feeding, bathing, dressing, and bedding changes, performed by a 
        friend or relative, if the individual so chooses.
            (12) The right, in the event of terminal illness, to die 
        with a maximum degree of dignity, to be provided all necessary 
        symptom relief, to be provided (and for the individual's family 
        to be provided) counseling and comfort, and to be allowed (if 
        desired) to die at home.
            (13) The right of access to a complaint and grievance 
        system and to legal assistance to enforce these rights.

SEC. 202. RIGHT TO PAID LEAVE TO RECEIVE HEALTH CARE SERVICES.

    (a) Amendment to Fair Labor Standards Act.--The Fair Labor 
Standards Act of 1938 is amended by inserting after section 7 (29 
U.S.C. 207) the following new section:

                  ``minimum health leave compensation

    ``Sec. 7A. Each employee of any employer who in any workweek is 
engaged in commerce or in the production of goods for commerce, or is 
employed in an enterprise engaged in commerce or in the production of 
goods for commerce, shall be entitled to receive from the employer, for 
each 35 hours he is employed by the employer (not counting more than 35 
hours in any workweek), compensation for one hour of employment at the 
regular rate at which the employee is employed (as that term is used in 
section 7 of this Act) for an hour--
            ``(1) during the period of 52 weeks beginning with the 
        workweek with which the entitlement is earned, and
            ``(2) during which the employee is unable to work because 
        of the need for the employee (or a dependent of that employee) 
        to receive necessary health care services.''.
    (b) Conforming Amendments.--The Fair Labor Standards Act of 1938 is 
further amended--
            (1) in section 3(o), by striking ``sections 6 and 7'' and 
        inserting ``sections 6, 7, and 7A'';
            (2) in section 13--
                    (A) by striking ``and 7'' in subsection (a) before 
                paragraph (1) and inserting ``, 7, and 7A'';
                    (B) by striking ``sections 6 and 7'' in subsection 
                (a)(3) and inserting ``sections 6, 7, and 7A''; and
                    (C) by inserting ``7A,'' in subsections (d) and (f) 
                after ``7,'' each place it appears;
            (3) in section 14(d), by striking ``6 and 7'' and inserting 
        ``6, 7, and 7A'';
            (4) in section 15(a), by striking ``section 6 or section 
        7'' and inserting ``section 6, 7, or 7A'';
            (5) in section 16--
                    (A) by striking ``section 6 or section 7'' in 
                subsection (b) and inserting ``section 6, 7, or 7A'';
                    (B) by striking ``or their unpaid overtime 
                compensation'' in subsection (b) and inserting ``their 
                unpaid overtime compensation, or their unpaid health 
                leave compensation'';
                    (C) by inserting ``or of unpaid health leave 
                compensation'' in subsection (b) after ``amount of 
                unpaid overtime compensation'';
                    (D) by striking ``section 6 or 7'' in the first 
                sentence of subsection (c) and inserting ``section 6, 
                7, or 7A'';
                    (E) by striking ``unpaid overtime compensation'' in 
                the first sentence of subsection (c) and inserting ``, 
                unpaid overtime compensation, or unpaid health leave 
                compensation'';
                    (F) by striking ``or overtime compensation'' in the 
                second sentence of subsection (c) and inserting ``, 
                overtime compensation, or health leave compensation''; 
                and
                    (G) by striking ``or unpaid overtime compensation 
                under sections 6 and 7'' in the third sentence of 
                subsection (c) and inserting ``, unpaid overtime 
                compensation, or unpaid health leave compensation under 
                sections 6, 7, and 7A''; and
            (6) in section 18--
                    (A) by inserting ``or minimum health leave 
                compensation higher than the minimum health leave 
                compensation established under this Act'' in the first 
                sentence of subsection (a) before ``, and no 
                provision''; and
                    (B) by inserting ``, or justify any employer in 
                reducing health leave compensation provided by him 
                which is in excess of the applicable minimum health 
                leave compensation under this Act'' before the period 
                at the end of the second sentence of subsection (a).

Subtitle B--Eligibility for, Nature of, and Scope of Services Provided 
                             by the Service

SEC. 211. ELIGIBILITY FOR SERVICES.

    (a) In General.--All individuals while within the United States are 
eligible to receive health care and supplemental services under this 
Act.
    (b) United States Defined.--For purposes of this section, the term 
``United States'' includes Indian reservations, the District of 
Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, 
Samoa, and the Northern Mariana Islands.

SEC. 212. ENTITLEMENT TO SERVICES.

    (a) In General.--Except as provided in subsection (b), the Service 
shall, on and after the effective date of health services, provide 
users with all health care services and supplemental services described 
in section 213 which the Service determines, in accordance with this 
title, to be necessary or appropriate for the promotion and enhancement 
of health, for the prevention of disease, and for the diagnosis and 
treatment of, and rehabilitation following, injury, disability, or 
disease.
    (b) Exclusion.--Services provided under this Act shall not include 
personal comfort or cosmetic services unless the National Health Board 
or its designee determines that the services are required for health-
related reasons.

SEC. 213. PROVISION OF HEALTH CARE AND SUPPLEMENTAL SERVICES.

    (a) In General.--The Service shall provide in the United States the 
following health care services in or through facilities established by 
the Service--
            (1) the promotion of health and well-being through health 
        education programs to be carried out in facilities of the 
        Service as well as in workplaces, schools, and elsewhere 
        utilizing all appropriate media, and by assisting other 
        Government agencies in taking appropriate actions to promote 
        health and well-being;
            (2) the prevention of illness, injury, and death through 
        education and advocacy addressed to the social, occupational, 
        and environmental causes of ill health; through the provision 
        of appropriate preventive services including social, medical, 
        occupational, and environmental health services, on both an 
        emergency and sustained basis; through screening and other 
        early detection programs to identify and ameliorate the primary 
        causes of ill health; and, where appropriate, through actions 
        taken on an emergency basis to halt environmental threats to 
        life and health;
            (3) the diagnosis and treatment of illness and injury, 
        including emergency medical services, comprehensive outpatient 
        and inpatient health care services, occupational health 
        services, mental health services, dental care, vision care, 
        long-term care, and home health services;
            (4) the rehabilitation of the sick and disabled, including 
        physical, psychological, occupational, and other specialized 
        therapies; and
            (5) the provision of drugs, therapeutic devices, 
        appliances, equipment, and other medical supplies (including 
        eyeglasses, other visual aids, dental aids, hearing aids, and 
        prosthetic devices) certified effective in the National 
        Pharmacy and Medical Supply Formulary (published under section 
        432(a)) and furnished or prescribed by authorized health 
        workers.
    (b) Supplemental Services.--The Service shall provide the following 
services supplemental to the delivery of health care services in or 
through health care facilities established by the Service--
            (1) ambulance and other transportation services to insure 
        ready and timely access to necessary health care;
            (2) child care services for individuals who, during the 
        time they receive outpatient health care services from the 
        Service or are working in a health care facility of the 
        Service, are responsible for a child's care;
            (3) homemaking and home health services--
                    (A) to enable the provision of inpatient health 
                services at a health care facility of the Service to an 
                individual who has the sole responsibility for the care
                            (i) of a child under 15 years of age, or
                            (ii) of a physically or mentally 
                        handicapped individual who requires the care of 
                        another individual, and
                    (B) for the bedfast or severely handicapped 
                individual; and
            (4) such counseling and social service assistance as will 
        avoid the unnecessary provision of health care services.
    (c) Local Public Health Services.--The Service shall maintain the 
functions, especially those related to environmental health and the 
prevention of illness, currently performed by the departments of health 
of the States and localities, to the extent consistent with Federal, 
State, and local law, and shall cooperate with State and local 
governments in its conduct of such functions.
    (d) Emergency Health Care Services.--The Service shall provide, at 
rates established by the National Health Board, for reimbursement of 
the cost of emergency health care services furnished in facilities not 
operated by the Service or by health workers not employed by the 
Service, when an injury or acute illness requires immediate medical 
attention under circumstances making it medically impractical for the 
ill or injured individual to receive care in a Service facility or by 
an employee of the Service.

Subtitle C--Health Care Facilities and Delivery of Health Care Services

SEC. 221. ESTABLISHMENT OF HEALTH CARE FACILITIES AND DISTRIBUTION OF 
              DELIVERY OF HEALTH CARE AND OTHER SERVICES.

    (a) Health Service Areas.--The National Health Board, in 
consultation with local authorities and residents of the local 
communities affected, shall establish such health care facilities as 
are necessary to provide all necessary comprehensive primary and 
specialized health care services, including distributing such health 
care resources in a manner as to overcome present shortages and ensure 
equitable access for every resident to needed health care resources. In 
establishing such facilities, the National Health Board shall rely 
primarily on existing political boundaries for the purposes of 
allocating health services, including cities, counties, perinatal 
services regions, States, and Federal Medicare regions, and shall 
determine the need to establish additional or supplementary regional 
health service areas that may cross existing boundaries.
    (b) Health Care Facilities.--
            (1) In general.--The National Health Board and its local 
        authorities shall, not later than the effective date of health 
        services and to the maximum extent feasible, establish and 
        maintain such health care facilities as are necessary for the 
        efficient and effective delivery to individuals of 
        comprehensive primary health care services (defined in 
        paragraph (2)), specialized health care services (defined in 
        paragraph (3)), special services (defined in paragraph (4)) and 
        community-oriented health measures (defined in paragraph (5)). 
        Such health care facilities shall be established and maintained 
        in a manner that, as soon as possible and to the greatest 
        extent feasible, provides services in each community through a 
        single comprehensive health center.
            (2) Comprehensive primary health care services defined.--As 
        used in paragraph (1), the term ``comprehensive primary health 
        care services'' means those basic outpatient health care 
        services typically needed for the promotion of health and the 
        prevention and treatment of common illnesses and includes the 
        following health care services--
                    (A) general primary medical and dental care, 
                including diagnosis and treatment, routine physical 
                examinations, laboratory, and radiologic services, and 
                home visits by health workers, as appropriate;
                    (B) preventive health services, including at least 
                immunizations, nutrition counseling and consultation, 
                and periodic screening and assessment services;
                    (C) children's health services, including 
                assessment of growth and development, education and 
                counseling on childrearing and child development, and 
                school and day care center health services;
                    (D) obstetrical and gynecological services, 
                including family planning and contraceptive services, 
                pregnancy (prenatal and postnatal) and abortion 
                counseling and services;
                    (E) comprehensive geriatric services;
                    (F) vision and hearing examinations and provision 
                of eyeglasses and other visual aids and hearing aids;
                    (G) 24-hour emergency medical services;
                    (H) provision of pharmaceuticals and therapeutic 
                devices, and medical appliances and equipment;
                    (I) mental health services, including psychological 
                and psychiatric counseling;
                    (J) home health services; and
                    (K) occupational safety and health services, 
                including screening, diagnosis, treatment, and 
                education.
            (3) Specialized health care services defined.--As used in 
        paragraph (1), the term ``specialized health care services'' 
        means those health care services of a specialized nature 
        (whether delivered in an inpatient or outpatient setting) 
        which, applying guidelines established by the National Health 
        Board, may be provided most effectively and efficiently in a 
        community setting.
            (4) Special services defined.--As used in paragraph (1), 
        the term ``special services'' means supportive services and the 
        facilities (including nursing homes and multiservice centers) 
        in which such services are provided for individuals who are 
        physically or mentally handicapped, mentally ill, infirm, or 
        chronically ill, so as to promote the integration and 
        functioning of such individuals within the community.
            (5) Community-oriented health measures defined.--As used in 
        paragraph (1), the term ``community-oriented health measures'' 
        includes efforts to focus organized community activities upon 
        the promotion of health and the prevention of illness and 
        injury, support for self-help and mutual aid groups offering 
        health promotion and rehabilitative support programs; 
        surveillance of potential threats to community health, and 
        prompt action to protect against such threats, and includes 
        outreach efforts to ensure that all residents are aware of and 
        able to utilize the health services of the Service, as needed.
    (b) Allocation of Hospitals.--The National Health Board, in 
consultation with its local authorities, shall periodically determine 
the necessity to establish and maintain inpatient and other specialized 
health care facilities in particular locations. Where found 
appropriate, it shall establish and maintain--
            (1) general hospitals for the efficient and effective 
        delivery of health care services to individuals requiring 
        inpatient diagnosis, treatment, care, and rehabilitation for 
        injury or illness; and
            (2) such other health care facilities as are necessary, 
        using guidelines established by the National Health Board to 
        promote the efficient and effective delivery of health care 
        services.
In addition, the Board shall distribute and provide such health care 
services of a specialized nature (whether delivered in an inpatient or 
outpatient setting) as may be provided most effectively and 
efficiently.
    (c) Specialized Services.--The Board shall, not later than the 
effective date of health services, establish and maintain--
            (1) specialized medical facilities for the efficient and 
        effective delivery of highly specialized health care services, 
        using guidelines it shall establish, to individuals requiring 
        highly specialized treatment, care, and rehabilitation for 
        injury or illness;
            (2) health care and supplemental services for individuals 
        whose health care are related to occupational or other factors, 
        including individuals residing within a region on a temporary 
        or seasonal basis (including migratory agricultural workers) 
        and individuals confined to prisons and other correctional 
        institutions; and
            (3) such other health care facilities as are necessary to 
        promote the efficient and effective delivery of health care 
        services.
    (d) Health Services.--States and the National Health Board, through 
its local and regional authorities, shall provide the following through 
health care facilities established pursuant to this section:
            (1) Health promotion through education on personal health 
        matters, nutrition, the avoidance of illness, and the effective 
        use of health care services with particular emphasis on the 
        appropriate and safe use (discouraging the overuse) of drugs 
        and medical techniques.
            (2) Maintenance and appropriate transmission and transferal 
        of personal health records for each user of the services 
        consistent with section 201(9).
            (3) Referral services, including referrals, where 
        appropriate, to other health care facilities.
            (4) Supplemental services (described in section 213(b)), as 
        appropriate.
            (5) Assistance to individuals who, because of language or 
        cultural differences or educational or other handicaps, are 
        unable fully to utilize the services available from and 
        delivered by the Board.
            (6) Information (A) on the rights ensured under this Act, 
        (B) on the guidelines and standards established by the Board, 
        and (C) on how the Board is implementing such rights and 
        applying such guidelines and standards.
            (7) Information on the grievance mechanisms established 
        pursuant to subtitle A of title IV and on legal services 
        available to pursue grievances against the Board.
            (8) Environmental health inspection and monitoring 
        services, including investigations relating to the prevention 
        of communicable diseases, in cooperation with State and local 
        authorities.
            (9) Research and data gathering on the leading causes of 
        ill health and injury and on health care delivery, in 
        accordance with section 421.
            (10) In the case of each inpatient health care facility, 
        discharge planning and followup services (A) to identify 
        patients who will need continuing care after discharge from the 
        facility and (B) to plan, with the patient and the patient's 
        family, arrangements and referrals to meet such postdischarge 
        needs.
    (e) Authorities.--
            (1) Effective delivery.--In its establishment of health 
        care facilities, the National Health Board shall seek to 
        minimize fragmentation and duplication in delivery of health 
        care and other services so as to promote the effective and 
        efficient delivery of such services.
            (2) Coordination.--The Board shall provide mechanisms to 
        coordinate care across political and geographic boundaries as 
        necessary.
            (3) Assuring availability and accessibility of services.--
        The Board shall take whatever additional steps are necessary to 
        ensure that all of the health services required under this 
        title are available and accessible in a timely manner to 
        adults, infants, children, and individuals with disabilities in 
        its region. Toward that end, it shall--
                    (A) ensure that users have access to a sufficient 
                number of each category of health worker, including 
                primary care providers, specialists, and other health 
                care professionals, in a manner so that, to the maximum 
                extent possible, such providers are geographically 
                accessible to all residences and workplaces within the 
                region and are culturally and linguistically 
                appropriate;
                    (B) ensure that services are available in a manner 
                which ensures continuity of care, availability within 
                reasonable hours of operation, and include emergency 
                and urgent care services which shall be accessible at 
                all times;
                    (C) ensure that any process established to 
                coordinate care shall ensure ongoing direct access to 
                relevant specialists and shall not impose an undue 
                burden on users with chronic health conditions;
                    (D) ensure that appropriate steps are taken to 
                eliminate any transportation or other barriers to the 
                timely receipt of services;
                    (E) ensure that a user who has a severe, complex, 
                or chronic condition shall have access to the most 
                appropriate health care coordinator (as defined in 
                paragraph (4)(A)); and
                    (F) ensure that priorities in the use of services 
                and facilities shall be set by the appropriate health 
                care professionals using criteria of medical necessity 
                and that any limitations or delay in access to services 
                shall be based only on limits of available service 
                personnel and physical facilities.
            (4) Definitions.--For purposes of this subsection:
                    (A) Health care coordinator.--The ``health care 
                coordinator'' means a health worker who performs case 
                management (as defined in subparagraph (B)) functions 
                in consultation with the health care team, the patient, 
                family, and community.
                    (B) Case management.--The term ``case management'' 
                means a coordinated set of activities conducted for the 
                management of an individual user's serious, 
                complicated, protracted or chronic health conditions in 
                order to ensure cost-effective and benefit maximizing 
                treatment.
    (f) Guidelines.--The National Health Board shall establish 
guidelines for distribution and coordination of the delivery of health 
care and other services described in this section and shall, before the 
effective date of health services, plan and facilitate the transition 
to the new distribution of health care facilities and health workers to 
be effected on and after that date.
    (g) Use of Evidence-Based Clinical Decision Criteria.--
            (1) In general.--The National Health Board shall authorize 
        the National Institute of Evaluative Clinical Research 
        described in section 422 to establish evidence-based clinical 
        decision criteria, where feasible, that shall apply throughout 
        the Nation.
            (2) Clinical decision criteria defined.--For purposes of 
        this section, the term ``clinical decision criteria'' means the 
        recorded (written or otherwise) screening procedures, decision 
        abstracts, clinical protocols, and practice guidelines used as 
        an important basis to determine the necessity and 
        appropriateness of health care services, in combination with 
        the facts of particular cases, the judgment of health care 
        professionals, and the preferences of users. Such criteria 
        shall be clearly documented and available to all health workers 
        and shall include a mechanism for periodically updating such 
        criteria.
    (h) Notice of Determinations.--The National Health Board, and its 
local and regional authorities, shall provide users with timely notice 
of any determination to provide, deny, or delay provision of a service, 
and information about the relevant clinical decision criteria upon 
which such determination is based, if any. Such notification shall 
include information concerning the appropriate procedure to appeal such 
decision.
    (i) Accountability.--In the case that the Health Service fails on 
the effective date of health services, to substantially and materially 
provide health care and supplemental services in accordance with this 
section, redress and alternative sources of care shall be authorized by 
an independent authority accountable to Congress and State 
legislatures. Such redress may include--
            (1) requiring the provision of services; and
            (2) providing reimbursement for the provision of specified 
        health care services in accordance with procedures and 
        schedules in effect under title XVIII of the Social Security 
        Act immediately before the effective date of health services.

SEC. 222. OPERATION AND INSPECTION OF HEALTH CARE FACILITIES.

    (a) Establishment of Policies.--
            (1) In general.--Each health care facility shall be subject 
        to policies and organizational plans consistent with this 
        section and with parts A and C of title III (relating to the 
        health labor force) for the operation of such facility and 
        shall establish procedures to ensure that the facility is 
        operated in accordance with such policies and plans.
            (2) Health worker and user control.--The National Health 
        Board and its regional and local authorities shall establish 
        policies and mechanisms for control of health care facilities 
        by health care workers who are employed in, and users who 
        receive services from, the respective facility, and shall 
        promulgate rules preventing a financial conflict of interest by 
        decisionmaking bodies.
    (b) Employment Restrictions.--
            (1) In general.--No individual entitled to make decisions 
        regarding establishment, allocation, or operation of a health 
        facility may engage in the private delivery of health care 
        services.
            (2) Private delivery of health care services defined.--For 
        the purposes of this subsection, the term ``private delivery of 
        health care services'' means the delivery of health care 
        services for which an individual, group, or organization 
        receives remuneration from any source other than the Health 
        Service Trust Fund established in section 511.
    (c) Operations of Health Care Facilities.--
            (1) Hours of operation.--Any health care facility which 
        provides health care services on an outpatient basis shall be 
        open during hours that will permit all users to make use of 
        such services.
            (2) Effective delivery.--In its establishment of health 
        care facilities under this section, the Board shall seek to 
        minimize fragmentation and duplication in delivery of health 
        care and other services so as to promote the effective and 
        efficient delivery of such services.

SEC. 223. PROVISION OF HEALTH SERVICES RELATING TO REPRODUCTION AND 
              CHILDBEARING.

    (a) Provision of Services.--
            (1) In general.--The following services shall be provided:
                    (A) Family planning.--
                            (i) Complete information on contraception 
                        and provision of birth control materials or 
                        medication of the individual's choosing.
                            (ii) Complete and effective evaluation and 
                        treatment of sexually transmitted diseases and 
                        diseases of the reproductive organs.
                            (iii) Complete information and counseling 
                        with respect to pregnancy, childbearing, and 
                        possible outcomes involving genetically induced 
                        anomalies.
                    (B) Pregnancy.--
                            (i) Complete and effective pregnancy 
                        testing.
                            (ii) Prenatal services, including physical 
                        examination, counseling, and instruction of 
                        expectant parents in nutrition, childrearing, 
                        and children's health care services.
                            (iii) Safe, comfortable, and convenient 
                        abortion services.
                            (iv) Counseling for women in conjunction 
                        with the provision of all gynecologic, female 
                        contraceptive, and abortion services and 
                        counseling for men on male fertility-related 
                        services.
            (2) Voluntary.--The services described in paragraph (1) 
        shall be delivered without coercion or harassment, with 
        complete confidentiality, and without prior approval of 
        individuals other than the individual receiving the services.
            (3) Accompaniment.--An individual shall be permitted to be 
        accompanied by a person of the individual's choice during the 
        provision of the services described in paragraph (1) to the 
        extent this would not significantly increase the medical risk 
        to the individual.
    (b) Voluntary Consent.--No health care provider may perform upon an 
individual a treatment or procedure (other than a treatment or 
procedure required to preserve the life of the individual) which could 
reasonably be expected to affect the individual's capacity to reproduce 
children, unless--
            (1) the individual has given voluntary written consent to 
        the treatment or procedure after being given 
complete information on the effect of the treatment or procedure on the 
individual's reproductive capacity, and on possible alternative 
treatments and procedures, at least 30 days before beginning the 
treatment or procedure, and
            (2) the individual has, after such 30-day waiting period, 
        again given written consent to the performance of the treatment 
        or procedure, except that in the case of a woman who has given 
        initial written consent to a sterilization she may be 
        sterilized in less than 30 days following such consent (but in 
        no case in less than 72 hours)--
                    (A) if she had given initial written consent at 
                least 30 days before her anticipated delivery date, she 
                delivers before the anticipated date, and the 
                sterilization is performed at the time of delivery;
                    (B) if she undergoes emergency abdominal surgery 
                within the 30-day waiting period and the sterilization 
                is concurrent with the abdominal surgery; or
                    (C) in the case of an elective sterilization 
                procedure, such as tubal ligation or vasectomy, that is 
                scheduled and performed separately from the act of 
                childbirth, where prior informed consent is provided 
                and the procedure is performed at the next subsequent 
                or any later medical visit after informed consent is 
                obtained.
    (c) Breast Cancer Treatment.--The National Health Board shall 
insure that, before a mastectomy or other breast cancer treatment is 
performed on a woman, the woman shall be provided with complete 
information on the complete range of medical options available for 
treatment of her condition and the risks and side effects of each 
option and an opportunity to consult individuals of her choice, and 
shall have given voluntary written consent to such procedure.
    (d) Birthing Options.--The National Health Board shall provide that 
a woman giving birth to an infant shall have the right to choose from a 
complete range of childbirth options including--
            (1) giving birth at home, in a birth center (if available), 
        or in a hospital;
            (2) the presence during childbirth of a person or persons 
        of her choosing;
            (3) the position for labor and delivery which she chooses;
            (4) caring for her infant at her bedside;
            (5) feeding her infant according to the method and schedule 
        of her choice; and
            (6) selecting the birth attendant of her own choice.
She shall be provided with information on the benefits, risks, and side 
effects of each option and an opportunity to consult individuals and 
groups of her choosing for information and assistance on these options.

                     TITLE III--HEALTH LABOR FORCE

              Subtitle A--Job Categories and Certification

SEC. 301. EFFECT OF STATE LAW.

    Notwithstanding any law of a State or political subdivision to the 
contrary, the Service, acting in accordance with the provisions of this 
Act, shall be the sole judge of the qualifications of its employees.

SEC. 302. QUALIFICATIONS OF HEALTH WORKERS.

    (a) Certification of Competence.--The National Health Board shall 
establish procedures which will ensure that, except in emergency 
situations, any work which is classified under a job category 
established under this subtitle is performed by a health worker who at 
the time of such work was--
            (1) certified (in accordance with this subtitle) as 
        competent to perform the work under such job category, and
            (2) authorized to perform such work by the employer of such 
        worker.
    (b) Periodic Assessments.--There shall be periodic review and 
assessment of the competency of such workers to perform the work within 
their job category, and opportunities for health workers to be assessed 
and certified with respect to skills required for advancement to other 
job categories.

SEC. 303. ESTABLISHMENT OF JOB CATEGORIES AND CERTIFICATION STANDARDS.

    (a) In General.--
            (1) Classification.--The National Health Board shall 
        establish such guidelines for the classification, 
        certification, and employment of health workers by job category 
        as it determines to be necessary--
                    (A) to ensure that health workers who perform work 
                for the Service which requires specialized skills have 
                demonstrated that they possess such skills,
                    (B) to expand the roles of health workers to enable 
                them to participate in health care delivery to the 
                maximum extent consistent with their skills, and
                    (C) to provide for affiliation of health workers 
                with health care facilities at the community, district, 
                and regional levels.
        These guidelines shall permit alternative approaches to 
        healing, and practitioners skilled in such approaches, when 
        these approaches have not been demonstrated to be injurious to 
        health.
            (2) Considerations.--In establishing guidelines under 
        paragraph (1), the National Health Board shall provide for (A) 
        sufficient flexibility to permit utilization of health workers 
        most effectively to meet the health needs of the region, and 
        (B) sufficient uniformity to permit mobility of health workers 
        among the regions.
    (b) Certification Standards.--
            (1) Establishment.--For each job category (other than a job 
        category determined by the National Health Board to involve 
        highly specialized skills requiring advanced specialty 
        training), the National Health Board shall, taking into account 
        the guidelines established under subsection (a), establish 
        certification standards which shall specify--
                    (A) the functions performed by a health worker 
                employed in such job category;
                    (B) the skills required in the course of properly 
                performing work under such job category;
                    (C) the initial and continuing training, 
                experience, and performance which must be undertaken or 
                demonstrated by a health worker to achieve and maintain 
                competency to perform the work within such job 
                category; and
                    (D) the curriculum which a health worker must 
                follow in studies in a health team school (established 
                under subtitle B) to demonstrate sufficient competence 
                to satisfy the specification of subparagraph (C) for 
                such job category.
            (2) Specifications.--For each job category established and 
        determined by the National Health Board to involve highly 
        specialized skills requiring advanced specialty training, the 
        National Health Board shall make the specifications described 
        in subparagraphs (A) through (D) of paragraph (1).
            (3) Periodic review.--Standards for a job category under 
        this subsection shall be periodically reviewed to supplement, 
        modify, or eliminate such standards as will facilitate the 
        delivery of quality health care services under this Act.
            (4) Quality protection.--
                    (A) Prohibition of downgrades of levels.--No 
                individual health facility administrator is authorized 
                to downgrade the level of skill, license or 
                certification required to perform duties delineated by 
                the Board.
                    (B) Review.--
                            (i) Review of staffing changes.--Upon 
                        enactment of this Act, the Board shall convene 
                        a national level task force to review the 
                        impact on the safety and health of patients and 
                        workers of downgrading and deskilling of health 
                        care job categories by replacing licensed with 
                        unlicensed workers during the 1990s, 
                        particularly in the nursing area, and to 
                        recommend remedies as appropriate.
                            (ii) Whistleblower protection.--Health care 
                        workers who report compromises in the quality 
                        of care shall not be subjected to 
                        recriminations.
                    (C) Workforce staffing levels.--The Board may 
                establish health workforce staffing levels as it 
                determines will promote the delivery of quality health 
                care services.

                Subtitle B--Education of Health Workers

SEC. 311. HEALTH TEAM SCHOOLS.

    (a) Establishment.--
            (1) In general.--Except as provided in paragraph (2), the 
        Board shall establish a procedure for converting existing 
        educational facilities for health services workers to create 
        health team schools (each in this subtitle referred to as a 
        ``school'') in accordance with this section to provide programs 
        of initial and continuing basic education in health care 
        delivery for health workers in all job categories, and to 
        provide initial continuing advanced education in health care 
        specialties and health science specialty fields. Such schools 
        shall be established and functioning not later than 4 years 
        after the effective date of health services.
            (2) Use of funds.--Schools shall be funded exclusively by 
        the Service, shall not charge nor accept tuition or fees for 
        enrollment, and shall provide each student with an adequate 
        allowance for living expenses, educational supplies, and any 
        child care expenses.
    (b) Operational Principles.--Schools shall be operated and 
maintained in accordance with the following principles:
            (1) The activities of each school shall be designed to meet 
        the health needs of the population.
            (2) The number of students enrolled in each educational 
        program in a school shall be based on the needs for health 
        workers within a given area, defined by geographic and 
        political boundaries.
            (3) Schools shall integrate the education of health workers 
        in the different job categories (established under subtitle A) 
        so as to permit health workers to be educated and certified for 
        successively higher levels of health care work.
            (4) Each school's admissions policies, curriculum policies, 
        faculty hiring procedures, and governance plan shall be 
        established and implemented in accordance with subsections (c) 
        through (f), respectively, and with the fullest possible 
        participation of the community health workers, staff, and 
        students in its region.
            (5) A school may not use individuals who are from low-
        income populations or minority groups, or who are women or 
        confined in mental or penal institutions, as subjects for 
        training or demonstration in numbers that are disproportionate 
        to their numbers in the population of the region, and may not 
        use any individuals as subjects for training or demonstration 
        in a manner beyond that required for the immediate purpose of 
        the training or demonstration or without their explicit 
        consent.
The National Health Board shall establish, not later than one year 
after the effective date of health services, guidelines for the 
application of these principles and for the phased integration of 
health worker education programs, including medical, dental, 
osteopathic, and nursing school programs, in existence on the date of 
enactment of this Act into the schools established under this section.
    (c) Admissions Policies.--Admissions policies for education 
programs in schools shall--
            (1) emphasize previous health-related work experience, as 
        evaluated by health workers (including peers), by individuals 
        who have received health care services from the applicant, and 
        by faculty members;
            (2) minimize the use of criteria of academic performance 
        other than such criteria as have been shown to be significantly 
        related to future work performance;
            (3) give preference to segments of the population of the 
        region underrepresented among health workers;
            (4) to the extent consistent with paragraph (3), provide 
        for admission of individuals so that the student body 
        approximates the population of the region by race, sex, family 
        income, and language; and
            (5) require that the applicant agree, if accepted into the 
        school, to perform health care services in accordance with 
        section 312.
    (d) Curriculum Policies.--The National Health Board, in 
consultation with its local and regional authorities, shall establish 
and implement curriculum policies for educational programs in schools. 
Such policies shall--
            (1) give priority in study and field work to the leading 
        causes of illness and death in the region, including 
        environmental, biological, and social determinants of mortality 
        and morbidity;
            (2) give special consideration to studying the social, as 
        well as biological, causation and prevention of illness and 
        disease, and to the differing health care needs of populations 
        facing special health risks and having special cultures and 
        lifestyles within the region;
            (3) provide that all students shall take a common, initial 
        sequence of courses and that students preparing for more 
        advanced types of health work shall take studies that are 
        progressively more specialized and differentiated;
            (4) emphasize work study experience in all types of health 
        care facilities in the region, including community and 
        workplace facilities, facilities for the aged, mentally ill, 
        and mentally retarded, health care facilities in prisons and 
        other correctional institutions, alcohol and drug 
        rehabilitation facilities, environmental health facilities, and 
        all other health care facilities of the Service in communities 
        and districts in the region;
            (5) emphasize the appropriate and safe use, and discourage 
        the overuse, of drugs and medical techniques; and
            (6) facilitate the development by all health workers of 
        skills in decisionmaking and assessment of user needs in 
        cooperation with other health workers and with users.
    (e) Faculty Hiring Procedures.--Faculty hiring procedures in 
schools shall, to the maximum extent feasible, create a faculty which 
approximates the population of the region by race, sex, and language.
    (f) Governance Plans.--Governance plans for the management of a 
school shall give significant decisionmaking powers to staff and 
students of the school.

SEC. 312. SERVICE REQUIREMENT.

    (a) Service Requirement.--
            (1) In general.--No individual may be enrolled in a school 
        unless the individual agrees to perform health care services as 
        an employee of the Service in the job category for which 
        training is being provided--
                    (A) for a period of time equal to the period of 
                such enrollment in the school but not less than 2 
                years;
                    (B) beginning not later than 1 year after the date 
                of the individual's graduation from the school; and
                    (C) for an area with the highest priority ranking 
                under subsection (c) that agrees to employ the 
                individual.
            (2) Deferral.--An individual's obligation to perform 
        service under an agreement described in paragraph (1) shall be 
        deferred only for a period during which the individual is 
        physically or mentally incapable of performing such service.
            (3) Completion of service required.--No individual who has 
        made an agreement described in paragraph (1) may be employed 
        other than in accordance with subsection (c), until the 
        individual has completed the period of obligated service in 
        accordance with this section.
            (4) Penalty for breach of agreement.--Except as provided in 
        paragraph (5), if an individual breaches an agreement under 
        paragraph (1) by failing (for any reason) either to begin such 
        individual's service obligation or to complete such service 
        obligation, the Service shall be entitled to recover from the 
        individual an amount determined in accordance with the formula 
        A=C (1-s / (t)) in which--
                    (A) ``A'' is the amount the Service is entitled to 
                recover;
                    (B) ``C'' is an amount determined by the National 
                Health Board to be the costs to the Service of the 
                education program and allowance received by the 
                individual and the interest on such costs which would 
                be payable if at the time the costs were undertaken 
                they were loans bearing interest at the maximum legal 
                prevailing rate, as determined by the Treasurer of the 
                United States;
                    (C) ``t'' is the total number of months in the 
                individual's period of obligated service; and
                    (D) ``s'' is the number of months of such period 
                served by the individual. Any amount of damages which 
                the Service is entitled to recover under this paragraph 
                shall, within the 1-year period beginning on the date 
                of the breach of the agreement, be paid to the Service.
            (5) Cancellation.--
                    (A) Upon death.--Any obligation of an individual 
                under this subsection for service or payment of damages 
                shall be canceled upon the death of the individual.
                    (B) Extreme hardship exception.--The National 
                Health Board shall provide for the waiver or suspension 
                of any obligation of service or payment by an 
                individual under this subtitle whenever compliance by 
                the individual is impossible or would involve extreme 
                hardship to the individual and if enforcement of such 
                obligation with respect to any individual would be 
                unconscionable.
                    (C) Limitation on discharge in bankruptcy.--Any 
                obligation of an individual under this subtitle for 
                payment of damages may be released by a discharge in 
                bankruptcy under title 11 of the United States Code 
only if such discharge is granted after the expiration of the 5-year 
period beginning on the first date that payment of such damages is 
required.
    (b) Periodic Reassessment of Worker Ratios.--The National Health 
Board shall periodically assess the ratio of the number of health 
workers employed by the Board in each job category (established under 
subtitle A) in an area to the number of residents in the area.
    (c) Worker Matches.--The National Health Board shall establish a 
program to match the locational preferences of graduates of schools 
with the needs and preferences of regions.

SEC. 313. PAYMENT FOR CERTAIN EDUCATIONAL LOANS.

    (a) Loan Payment Program.--In the case of any individual who has 
incurred any educational loan before the fourth year after the 
effective date of health services and for the individual's costs for an 
educational program in health care delivery, health care specialties, 
or health science specialty fields, the National Health Board shall 
make payments, in accordance with subsection (b), for and on behalf of 
that individual, on the principal of and interest on any such loan 
which is outstanding on the date the individual begins to work for the 
Service.
    (b) Making of Payment.--The payments described in subsection (a) 
shall be made by the National Health Board as follows:
            (1) Upon completion by the individual for whom the payments 
        are to be made of the first year of employment with the 
        Service, the National Health Board shall pay 30 percent of the 
        principal of, and the interest on, each loan described in 
        subsection (a) which is outstanding on the date he began such 
        employment.
            (2) Upon completion by that individual of the second year 
        of such employment, the National Health Board shall pay another 
        30 percent of the principal of, and the interest on, each such 
        loan.
            (3) Upon completion by that individual of a third year of 
        such employment, the National Health Board shall pay another 25 
        percent of the principal of, and the interest on, each such 
        loan.
            (4) Upon completion by that individual of a fourth year of 
        such employment, the National Health Board shall pay the 
        remaining 15 percent of the principal of, and all remaining 
        interest on, each such loan.
No payment may be made under this subsection with respect to a loan 
unless the person on whose behalf the payment is to be made has 
submitted to the National Health Board a certified copy of the 
agreement under which such loan was made.
    (c) Payment During Employment.--Notwithstanding the requirement of 
completion of employment specified in subsection (b), the National 
Health Board shall on or before the due date thereof, pay any loan or 
loan installment which may fall due within the period of employment for 
which the borrower may receive payments under this section, upon the 
declaration of such borrower, at such times and in such manner as the 
National Health Board may prescribe (and supported by such other 
evidence as the National Health Board may reasonably require), that the 
borrower is then employed as described in subsection (b) and that the 
borrower will continue to be so engaged for the period required (in the 
absence of this subsection) to entitle the borrower to have made the 
payments provided by this section for such period, except that not more 
than 85 percent of the principal of any such loan shall be paid 
pursuant to this subsection.

   Subtitle C--Employment and Labor-Management Relations Within the 
                                Service

SEC. 321. EMPLOYMENT, TRANSFER, PROMOTION, AND RECEIPT OF FEES.

    (a) Service Employees.--The National Health Board shall employ, 
classify, and fix the salaries and benefits of all employees of the 
Service employed in the Service's facilities.
    (b) Policies.--The National Health Board, in establishing 
guidelines and standards under this subtitle, shall, to the extent 
feasible and consistent with the provisions of this subtitle, provide 
for--
            (1) employment and promotion in the Service in the same 
        manner as is provided for employment and promotion under the 
        Federal civil service system;
            (2) meaningful opportunities for career advancement;
            (3) encouragement of health workers to use up to 10 percent 
        of their work time for continuing education under subtitle B 
        without loss of pay or other job rights; and
            (4) full protection of employees' rights by providing an 
        opportunity for a fair hearing on adverse actions with 
        representation of their own choosing.
    (c) Hiring Preferences.--The National Health Board, in hiring for 
employees to fill vacancies in newly created positions, shall give 
preference to individuals who were employed as health workers, or self-
employed while delivering health services, before the date of enactment 
of this Act. The National Health Board shall ensure, through such steps 
as it deems necessary, that all such individuals desiring to be 
employed within the Service shall find appropriate employment in the 
Service.
    (d) Promotion and Transfer.--Employees of the Service shall be 
eligible for promotion or transfer to any position in the Service for 
which they are qualified. A job placement service in each region shall 
assist health workers in its region in identifying suitable employment 
opportunities and in transferring between jobs. The authority given by 
this subsection shall be used to provide a maximum degree of career 
opportunities for employees and to ensure continued improvement of 
health care services.
    (e) No Undue Financial Incentives.--No health worker should benefit 
financially from the provision or denial of services to individual 
patients, beyond their regular remuneration.
    (f) Sole Employer.--An employee of the Service may not receive any 
fee or perquisite on account of duties performed by virtue of such 
employment except from the Service.
    (g) Grandfather Clause.--The National Health Board shall support 
alternative procedures to assure that health care professionals meet 
required standards, particularly those currently practicing in health 
professional shortage areas in inner cities and in rural communities.
    (h) Transitional Employment.--Up to 1 percent of the budget of the 
United States Health Service for each of its first 2 years may be 
expended for the retraining and hiring of sales, administrative, 
clerical, and service employees displaced as a result of this Act, 
including those in the health insurance industry.

SEC. 322. APPLICABILITY OF LAWS RELATING TO FEDERAL EMPLOYEES.

    (a) In General.--Chapter 75 of title 5, United States Code 
(relating to adverse actions against employees), apply to employees of 
the Service (other than employees serving on the personal staff of 
members of health boards) except to the extent provided--
            (1) in a collective bargaining agreement negotiated on 
        behalf of and applicable to them; or
            (2) in procedures established by the Service and approved 
        by the Office of Personnel Management.
    (b) Coverage Under Workers Compensation.--Employees of the Service 
are covered by subchapter I of chapter 81 of title 5, United States 
Code (relating to compensation for work injuries).
    (c) Civil Service.--
            (1) Application of civil service retirement.--Chapter 83 of 
        title 5, United States Code (relating to civil service 
        retirement), applies to employees of the Service except to the 
        extent provided in a collective bargaining agreement negotiated 
        on behalf of and applicable to them.
            (2) Withholding.--The Service shall withhold from pay and 
        shall pay into the Civil Service Retirement and Disability Fund 
        the amounts specified in chapter 83 of title 5, United States 
        Code, as required under paragraph (1). The Service, upon 
        request of the Office of Personnel Management, but not less 
        frequently than annually, shall pay to the Office the costs 
        reasonably related to the administration of Fund activities for 
        employees of the Service.
    (d) Accrual of Sick and Annual Leave.--Sick and annual leave and 
compensatory time of employees of the Service, whether accrued prior to 
or after the commencement of operations of the Service, shall be 
obligations of the Service.
    (e) Application of Conditions.--
            (1) Terms of employment.--Compensation, benefits, and other 
        terms and conditions of employment in effect on the effective 
        date of health services for employees of the Federal Government 
        performing functions that are provided under this Act by the 
        Service, shall apply to all employees of the Service performing 
        similar functions until changed by the Service in accordance 
        with this Act. Subject to the provisions of this Act, the 
        provisions of subchapter I of chapter 85 and chapter 87 of 
        title 5, United States Code (relating to unemployment 
        compensation and life insurance), apply to employees of the 
        Service unless varied, added to, or substituted for in 
        accordance with paragraph (2).
            (2) Limitation on variation.--No variation, addition, or 
        substitution with respect to fringe benefits shall result in a 
        program of fringe benefits which on the whole is less favorable 
        to employees of the Service than fringe benefits in effect for 
        employees of the Federal Government on the effective date of 
        health services. No variation, addition, or substitution with 
        respect to fringe benefits of employees for whom there is a 
        collective bargaining representative shall be made except by 
        agreement between such representative and the Service.

SEC. 323. APPLICABILITY OF FEDERAL LABOR-MANAGEMENT RELATIONS LAWS.

    (a) Application of NLRA.--
            (1) In general.--The provisions of the National Labor 
        Relations Act (42 U.S.C. 141 et seq.) shall apply to the 
        Service and its employees to the extent, not inconsistent with 
        subsection (b), to which such provisions apply to employers (as 
        defined in section 2(2) of such Act), except that--
                    (A) the phrase ``or any individual employed as a 
                supervisor'' in section 2(3) of such Act shall not 
                apply (thereby making such Act apply, for these 
                purposes, to such individuals);
                    (B) section 9(b)(1) of such Act (providing for 
                separate treatment for professional and nonprofessional 
                employees) shall not apply;
                    (C) sections 206 through 210 of such Act (relating 
                to national emergencies) shall, for purposes of this 
                Act, have the phrases ``the President of the United 
                States'' and ``the President'', wherever they appear, 
                replaced by the phrase ``the National Health Board (or 
                a committee thereof to which it has delegated such 
                authority)'' and the phrase ``national health or 
                safety'' replaced by the phrase ``health or safety of 
                the residents of any region''; and
                    (D) section 213 (providing for intervention in a 
                strike or lockout by the Director of the Federal 
                Mediation and Conciliation Service) shall not apply.
            (2) Strikes permitted.--Paragraphs (3) and (4) of section 
        7311 of title 5, United States Code (prohibiting participation 
        in a strike or an organization asserting the right to strike), 
        shall not apply to employees of the Service.
    (b) Neutrality in Union Matters.--The National Health Board shall 
adopt as a matter of general policy that governing boards at each level 
of the Service, and employers acting as agents of these boards, agree 
to determine employee preference on the subject of labor union 
representation, and to determine which one if union representation is 
preferred, by a card check procedure conducted by a neutral third party 
in lieu of a formal election.
    (c) Collective Bargaining.--
            (1) In general.--Collective bargaining agreements between 
        the National Health Board and duly recognized bargaining 
        representatives of employees of the Service may include 
        procedures for resolution by the parties of grievances and 
        adverse actions arising under the agreement, including 
        procedures culminating in binding third party arbitration.
            (2) Alternative procedures.--The National Health Board and 
        duly recognized bargaining representatives of employees of the 
        Service may by mutual agreement adopt procedures for the 
        resolution by the parties--
                    (A) of grievances and adverse actions arising under 
                collective bargaining agreements, and
                    (B) of disputes or impasses arising in the 
                negotiation of such agreements.
    (d) Conforming Amendment.--Section 3(e) of the Labor-Management 
Reporting and Disclosure Act of 1959 (42 U.S.C. 402(e)) is amended by 
inserting ``the United States Health Service and'' after ``and 
includes''.

SEC. 324. DEFENSE OF CERTAIN MALPRACTICE AND NEGLIGENCE SUITS.

    (a) Exclusive Remedy.--The remedy against the United States 
provided by sections 1346(b) and 2672 of title 28, United States Code, 
or by alternative benefits provided by the United States where the 
availability of such benefits precludes a remedy under section 1346(b) 
of such title, for damage for personal injury, including death, 
resulting from the performance of medical, surgical, dental, or related 
functions, including the conduct of clinical studies or investigations, 
by any employee of the Service while acting within the scope of the 
employee's employment, shall be exclusive of any other civil action or 
proceeding by reason of the same subject matter against the employee 
(or the employee's estate) whose act or omission gave rise to the 
claim.
    (b) Defense.--The Attorney General shall defend any civil action or 
proceeding brought in any court against any person referred to in 
subsection (a) (or the person's estate) for any such damage or injury. 
Any such person against whom such civil action or proceeding is brought 
shall deliver within such time after date of service or knowledge of 
service as determined by the Attorney General, all process served upon 
the person or an attested true copy thereof to the person's immediate 
superior or to whomever was designated by the appropriate National 
Health Board to receive such papers and such person shall promptly 
furnish copies of the pleading and process therein to the United States 
attorney for the district embracing the place wherein the proceeding is 
brought, to the Attorney General, and to the National Health Board.
    (c) Procedure.--
            (1) Removal from state courts.--Upon a certification by the 
        Attorney General that the defendant was acting in the scope of 
        employment at the time of the incident out of which the suit 
        arose, any such civil action or proceeding commenced in a State 
        court shall be removed without bond at any time before trial by 
        the Attorney General to the district court of the United States 
        of the district and division embracing the place wherein it is 
        pending and the proceeding deemed a tort action brought against 
        the United States under the provision of title 28, United 
        States Code, and all references thereto.
            (2) Motions to remand.--If a United States district court 
        determines on a hearing on a motion to remand held before a 
        trial on the merits that the case so removed is one in which a 
        remedy by suit within the meaning of subsection (a) is not 
        available against the United States, the case shall be remanded 
        to the State court.
            (3) Effect of alternative remedies.--Where a remedy by suit 
        within the meaning of subsection (a) is not available because 
        of the availability of a remedy through proceedings for 
        compensation or other benefits from the United States as 
        provided by any other law, the case shall be dismissed, but in 
        the event the running of any limitation of time for commencing, 
        or filing an application or claim in, such proceedings for 
        compensation or other benefits shall be deemed to have been 
        suspended during the pendency of the civil action or proceeding 
        under this section.
    (d) Settlement.--The Attorney General may compromise or settle any 
claim asserted in such civil action or proceeding in the manner 
provided in section 2677 of title 28, United States Code, and with the 
same effect.
    (e) Limitation.--For purposes of this section, the provisions of 
section 2680(h) of title 28, United States Code, shall not apply to 
assault or battery arising out of negligence in the performance of 
medical, surgical, dental, or related functions, including the conduct 
of clinical studies or investigations.
    (f) Liability Insurance.--The appropriate National Health Board 
may, to the extent it deems appropriate, hold harmless or provide 
liability insurance for any employee of the Service for damage for 
personal injury, including death, negligently caused by such employee 
while acting within the scope of employment and as a result of the 
performance of medical, surgical, dental, or related functions, 
including the conduct of clinical studies or investigations, if the 
employee is assigned to a foreign country or detailed to a State or 
political subdivision thereof or to a nonprofit institution, and if the 
circumstances are such as are likely to preclude the remedies of third 
persons against the United States described in section 2679(b) of title 
28, United States Code, for such damage or injury.

               TITLE IV--OTHER FUNCTIONS OF HEALTH BOARDS

      Subtitle A--Advocacy, Grievance Procedures, and Trusteeships

SEC. 401. ADVOCACY AND LEGAL SERVICES PROGRAM.

    (a) Establishment of Program.--The National Health Board shall 
establish a program of health advocacy to ensure the full realization 
of the patient rights enumerated in subtitle A of title II. Such a 
program shall include--
            (1) the employment of individuals having basic legal 
        knowledge and skills as health advocates;
            (2) the presence of health advocates--
                    (A) in inpatient health care facilities at all 
                times; and
                    (B) in other health care facilities during the 
                provision of health care services;
            (3) provision for health advocates to (A) inform, on an 
        ongoing basis, users and health workers of such patient rights 
        and (B) report to the National Health Board any infraction of 
        such rights which is not promptly corrected;
            (4) provision for regular meetings between health workers 
        and health advocates, users, and any user representatives to 
        discuss ways of ensuring the fulfillment of such rights through 
        affirmative action of such workers and the National Health 
        Board; and
            (5) appropriate action by the National Health Board to 
        ensure that infractions of such rights are promptly and 
        sufficiently corrected.
    (b) Health Rights Legal Services.--
            (1) Establishment of program.--The National Health Board 
        shall establish a health rights legal services program and 
        shall provide such program with sufficient legal and 
        administrative personnel, funding, and facilities (A) to ensure 
        that users and health workers receive, free of charge, high 
        quality legal services (including representation in grievance 
        proceedings commenced under section 402) for legal problems 
        related to health rights and health care services, and (B) to 
        improve, through litigation and other activities, the health 
        care system and expand the rights of users and health workers.
            (2) Services.--The health rights legal services program 
        shall provide directly, by contract with the Legal Services 
        Corporation, or by contract with members of the private bar, 
        for--
                    (A) establishment of a legal services office in 
                each region to provide representation (other than 
                representation provided under subparagraph (B)) of 
                users, health workers, and voluntary associations 
                having a demonstrated interest in health care in 
                proceedings and hearings under sections 324 and 402; 
                and
                    (B) establishment of legal services offices in such 
                communities and districts as are determined, in 
                accordance with guidelines established by the National 
                Health Board, to have inadequate legal services to 
                provide the legal services described in paragraph 
                (1)(A).
            (3) Use of contracts.--The National Health Board may carry 
        out the functions described in paragraph (1)(B) directly, by 
        contract, or otherwise.

SEC. 402. GRIEVANCE PROCEDURES.

    (a) Grievance Proceedings.--
            (1) In general.--The National Health Board shall provide, 
        in accordance with this section, that any user, health worker, 
        or any user association having a demonstrated interest in 
        health care may commence a grievance proceeding before the 
        Board (or a person or committee designated by such Board) with 
        respect to an alleged violation of this Act. The National 
        Health Board may commence a grievance proceeding before itself 
        (or a person or committee designated by such Board) with 
        respect to an alleged violation of this Act.
            (2) Grievances against national health board.--Grievances 
        against the National Health Board may be presented to and 
        adjudicated by the Inspector General for Health Services or the 
        Inspector's General local designees. Grievants shall also have 
        access to review in the courts.
    (b) Review.--
            (1) By national health board.--The National Health Board 
        shall provide, subject to paragraphs (2) and (3), for its 
        review (or a review by a person or committee designated by the 
        Board), by appeal to the Board by any party to a proceeding 
        described in subsection (a)(1) or on its own initiative, of an 
        adverse decision
            (2) Limitation once suit commenced.--On and after the date 
        a suit with respect to an adverse determination in a grievance 
        proceeding or review proceeding is filed under subsection (e), 
        no review proceeding respecting such proceeding may be 
        commenced by appeal to the Board under paragraph (1), and any 
        such review proceeding which was commenced by appeal to the 
        Board under such paragraph before the date of filing of such 
        suit and is pending on such date shall promptly be 
        discontinued.
            (3) Time limit.--No review of an adverse administrative 
        decision may be made by appeal or by initiative under this 
        subsection unless the appeal is filed or notice of the 
        initiative is published (as the case may be) not later than 30 
        days after the publication of the decision.
    (c) Investigation.--Whenever a grievance proceeding is commenced 
under subsection (a), the entity before which the proceeding is held 
shall investigate the grievance.
    (d) Right To Sue.--Any party to a grievance proceeding or review 
proceeding commenced under this section may bring suit in the United 
States district court for the judicial district in which such 
proceeding, or review proceeding, was brought, for the review of an 
adverse determination in such proceeding or review proceeding. Such 
court shall affirm such determination unless it finds that such 
determination is not supported by substantial evidence or is arbitrary 
and capricious.

          Subtitle B--Occupational Safety and Health Programs

SEC. 411. FUNCTIONS OF THE NATIONAL HEALTH BOARD.

    (a) Oversight Authority.--On and after the effective date of health 
services, the National Health Board shall oversee occupational safety 
and health programs conducted at the regional level, and shall 
participate in the establishment and administration of occupational 
safety and health standards under the Occupational Safety and Health 
Act of 1970.
    (b) Conforming Amendments.--
            (1) In general.--To provide for participation of the 
        National Health Board in the establishment and administration 
        of occupational safety and health standards, the Occupational 
        Safety and Health Act of 1970 (29 U.S.C. 651 et seq.) is 
        amended--
                    (A) in section 3, by adding at the end the 
                following new paragraph:
            ``(15) The term `National Health Board'' means the National 
        Health Board of the United States Health Services.'';
                    (B) by striking ``Secretary of Health and Human 
                Services'' each place it appears (other than in section 
                22(b)) and inserting ``National Health Board'';
                    (C) in the first sentence of section 6(b)(1), by 
                inserting ``shall request the National Health Board 
                and'' before ``may request'';
                    (D) in the second sentence of section 6(b)(1), by 
                inserting ``the Board and'' after ``The Secretary shall 
                provide'';
                    (E) in the third sentence of section 6(b)(1), by 
                striking ``An'' and inserting ``The Board and an'';
                    (F) in the third sentence of section 6(b)(1), by 
                striking ``its'' each place it appears and inserting 
                ``their'';
                    (G) in the fourth sentence of section 6(b)(6)(A), 
                by inserting ``after consultation with the National 
                Health Board and'' after ``may be granted only'';
                    (H) in the third sentence of section 6(d), by 
                inserting ``after consultation with the National Health 
                Board and'' before ``after opportunity for'';
                    (I) in section 8(g)(2), by striking ``The 
                Secretary'' and all that follows through ``shall each'' 
                and inserting ``The Secretary shall'';
                    (J) in section 8(g)(2), by striking ``their'' and 
                inserting ``his'';
                    (K) in section 16, by inserting ``after 
                consultation with the National Health Board and'' 
                before ``after notice and opportunity'';
                    (L) in section 18(c), by inserting ``(after 
                consultation with the National Health Board)'' after 
                ``in his judgment'';
                    (M) in section 19(d), by inserting ``and the 
                National Health Board'' after ``Secretary'' each place 
                it appears; and
                    (N) in section 20(a), by striking the first 
                sentence of paragraph (5).
            (2) Effective date.--The amendments made by paragraph (1) 
        shall take effect on the effective date of health services.
    (f) Guidelines.--The National Health Board shall establish 
guidelines--
            (1) for its participation in the establishment and 
        administration of occupational safety and health standards 
        under the Occupational Safety and Health Act of 1970; and
            (2) for the establishment and operation of workplace health 
        facilities under section 413.

SEC. 412. COMMUNITY OCCUPATIONAL SAFETY AND HEALTH ACTIVITIES.

    The Occupational Safety and Health Administration, under the 
direction of the National Health Board, shall develop and provide staff 
support for local and regional occupational safety and health programs, 
to include community-based occupational safety and health councils that 
represent community workers and residents. Such programs shall--
            (1) promote and assist in the establishment of workplace 
        occupational safety and health committees in workplaces in the 
        community, and advise and facilitate such committees' actions 
        relating to safety and health hazards in workplaces in the 
        community; and
            (2) assist employees in determining methods of, and 
        requirements for, inspections of workplaces in the community 
        for safety and health hazards.
                    (A) implement training programs to enhance the 
                ability of employees in the region to monitor safety 
                and health conditions in their workplaces and to assist 
                safety and health inspectors in the conduct of 
                workplace inspections;
                    (B) facilitate communication among workers employed 
                in similar industries in the region and the Nation with 
                respect to occupational health and safety hazards they 
                face in common;
                    (C) conduct baseline and periodic biologic 
                screening of employees in the region;
                    (D) develop and maintain environmental monitoring 
                programs to identify and isolate hazardous workplaces 
                and work areas in the region;
                    (E) analyze employment-related injuries and 
                illnesses occurring in the region

SEC. 413. WORKPLACE HEALTH FACILITIES.

    (a) Establishment.--The Occupational Safety and Health 
Administration, under the direction of the National Health Board, shall 
develop a program to establish worksite health facilities, distributed 
to make available occupational and emergency health care services to 
individuals employed in the workplace in accordance with this section 
and guidelines and standards for such facilities established by the 
National Health Board. Such facilities may be maintained by each 
employer where the facility is located, or by the group of employers 
covered by a facility.
    (b) Application of Guidelines.--Each workplace health facility 
established pursuant to subsection (a) shall, taking into account 
guidelines established by the National Health Board--
            (1) be organized in a manner so as to provide an 
        appropriate number of appropriately skilled health workers to 
        meet occupational and emergency health care needs of employees 
        in the workplace; and
            (2) be operated by the community for the community in which 
        the workplace is predominantly located, or, where the National 
        Health Board or its local authority deems appropriate, by the 
        employer, with the cost in either case borne by the employer in 
        each workplace.

SEC. 414. EMPLOYEE RIGHTS RELATING TO OCCUPATIONAL SAFETY AND HEALTH.

    (a) Workplace Committees.--
            (1) Establishment.--Employees in each workplace having 25 
        or more employees shall have the right to establish workplace 
        occupational safety and health committees (each in this 
        subsection referred to as a ``committee'') with members of 
        their choosing.
            (2) Membership.--Members of committees (composed of the 
        greater of 3 members or one member for each 100 employees in 
        the workplace) shall, without any loss of pay or other job 
        rights--
                    (A) be permitted to spend eight hours of each month 
                inspecting their workplace and conducting such other 
                functions relating to occupational safety and health as 
                are determined by the employees in the workplace; and
                    (B) be permitted to accompany any safety and health 
                inspectors during inspections of the workplace.
    (b) Safety-Related Rights.--Employees in each workplace shall have 
the right, without any loss of pay or other job rights--
            (1) to monitor safety and health conditions in their 
        workplace whenever they reasonably deem it necessary and with 
        whatever reasonable scientific instruments and expert 
        assistance they choose; and
            (2) to remove themselves from the site of any hazard to 
        their safety or health until an authorized inspector has 
        certified that the hazard has been eliminated.
    (c) Safe Workplaces.--Employers shall adopt all feasible 
engineering measures that will minimize occupational safety and health 
hazards in the workplace. Where such measures are not adequate to 
protect employees from such hazards, employers shall furnish their 
employees with, or reimburse their employees for the reasonable cost 
of, equipment and clothing needed to protect an employee from any 
residual occupational safety and health hazards in the workplace.
    (d) Right To Inspect Medical Records.--Employees or their duly 
chosen representatives shall have the right to inspect all medical 
records maintained by their employers on the condition of their health, 
and shall have the right to be assisted during such inspections by 
persons of their choosing.
    (e) Copies of Reports.--Employers shall provide their employees 
with copies of all reports, studies, and data concerning conditions 
affecting the health and safety of employees within their workplaces, 
with annual reports on the morbidity and mortality experience of 
present and former employees, and with timely notification of the 
presence within the workplace of any materials, agents, or conditions 
which may have a deleterious effect on the safety and health of their 
employees, along with relevant information on hazards and precautions, 
symptoms, remedies, and antidotes.
    (f) Right To Negotiate Standards.--Employees shall have the right 
to seek, through collective bargaining, occupational safety and health 
standards, including standards relating to physical and mental stress 
and speed of work, more restrictive than such standards established 
under the Occupational Safety and Health Act of 1970.

SEC. 415. DEFINITIONS.

    (a) Workplace.--For purposes of this subtitle, the term 
``workplace'' means the regular location where work is performed by one 
or more employees of an employer.
    (b) Employer; Employee.--For the purposes of sections 413 and 414, 
the terms ``employer'' and ``employee'' have the same meanings those 
terms have in section 3 of the Occupational Safety and Health Act of 
1970 (42 U.S.C. 653).

     Subtitle C--Health and Health Care Delivery Research, Quality 
                      Assurance, and Health Equity

SEC. 421. PRINCIPLES AND GUIDELINES FOR RESEARCH.

    (a) Conduct.--On and after the effective date of health services, 
the Service shall conduct a program of research concerning health and 
health care delivery. On and after 2 years after such date, such 
research program shall conform to the following principles:
            (1) The research shall, to the maximum extent possible, be 
        performed under the direction of, and in association with, 
        agencies representative of the population.
            (2) No research shall be conducted within, or using the 
        resources of, an area health facility until it has been 
        reviewed and approved by the National Health Board, or a 
        designated local authority responsible for such facility.
            (3) Priority shall be given in health research to the 
        prevention and correction of the leading causes of illness and 
        death, particularly environmental, occupational, nutritional, 
        social, and economic causes.
            (4) Priority shall be given in health care delivery 
        research to improvement of the effectiveness and efficiency of 
        ambulatory and primary health care delivery, including research 
        on alternative systems of health care delivery and alternative 
        conceptions of health and health care.
            (5) The National Health Board shall encourage and support 
        the conduct of clinical trials that may improve the health of 
        the public. Any clinical trial conducted with the intention of 
        evaluating new preventive, diagnostic, or therapeutic methods 
        or agents shall be conducted only in accordance with 
        established ethical procedures that protect subjects from undue 
        harm. If benefit becomes apparent, by scientific consensus, 
        before the scheduled conclusion of any clinical trial, such 
        trial shall nevertheless be terminated, and the benefit made 
        available to trial participants and the public at large.
            (6) No research shall be conducted on a human subject 
        without the subject's informed written consent.
            (7) No research shall be conducted on a human subject while 
        the subject is involuntarily confined to an institution.
            (8) The planning and conduct of research under the program, 
        shall take place in cooperation with appropriate officials 
        conducting related research in the Federal Government and 
        agencies and departments of State, territorial, and local 
        governments.
            (9) The results of research shall be disseminated to the 
        public and to National Health Board in a manner that will most 
        readily permit the use of such results to improve the health of 
        users and the delivery of health care services.
    (b) Guidelines.--The National Health Board shall establish 
guidelines for the conduct of research in conformance with the 
principles described in subsection (a).

SEC. 422. ESTABLISHMENT OF INSTITUTES.

    (a) In General.--On the effective date of health services, the 
agencies of the Department of Health and Human Services that conduct 
research on health and health care are transferred to the National 
Health Board. These include the Agency for Healthcare Research and 
Quality, the Agency for Toxic Substances and Disease Registry, the 
Centers for Disease Control and Prevention, the National Institutes of 
Health (established under title IV of the Public Health Service Act), 
and the Substance Abuse and Mental Health Services Administration. In 
addition, the National Health Board shall establish the following 
institutes:
            (1) National institute of epidemiology.--A National 
        Institute of Epidemiology, which shall--
                    (A) gather and analyze disease-related statistics 
                collected by the Service;
                    (B) plan, conduct, support, and assist in 
                epidemiologic research conducted by the Service;
                    (C) conduct and support research on epidemiologic 
                methodology and experimental epidemiology;
                    (D) establish and maintain an early warning system 
                for the detection of new diseases and epidemics; and
                    (E) assist in the formulation of policies to 
                eliminate or reduce the causes of illness and injury 
                and to prevent and curtail epidemics of these 
                conditions.
                    (F) provide technical assistance and support to 
                regional and local jurisdictions related to measures to 
                prevent and curtail outbreaks of illness and injury.
            (2) National institute of evaluative clinical research.--A 
        National Institute of Evaluative Clinical Research, which 
        shall--
                    (A) create a uniform electronic data base for 
                research on quality improvement in clinical care and 
                the organization and delivery of services, and for 
                research on outcomes of care;
                    (B) assess and analyze evidence on newly discovered 
                or proposed preventive, diagnostic, and therapeutic 
                methods and agents, including new technologies, and 
                assist the National Health Board, in cooperation with 
                other bodies, including the National Institute of 
                Pharmacy and Medical Supply, in developing guidelines 
                and standards for their introduction;
                    (C) analyze evidence on newly discovered or 
                proposed preventive, diagnostic, and therapeutic 
                methods and agents;
                    (D) plan and conduct clinical trials, in 
                conformance with the limitations of subtitle A of title 
                II;
                    (E) assist the National Health Board, in 
                cooperation with other bodies, including the National 
                Institute of Pharmacy and Medical Supply, in developing 
                guidelines and standards for the introduction of new 
                methods of prevention, diagnosis, and treatment;
                    (F)(i) regularly assess and recommend measures to 
                improve the health status of the population, which 
                methods shall include analysis of the national health 
                data base, regular surveys of the population regarding 
                their experience and evaluation of their health and 
                health services, and such other methods as designated 
                by the Institute;
                    (ii) identify the most effective methods of 
                prevention, diagnosis and treatment, as determined by 
                the most recent evidence, and assist the National 
                Health Board, in cooperation with other bodies, in 
                establishing guidelines to improve clinical practice, 
                including clinical decision criteria per section 
                221(f);
                    (iii): regularly monitor and report to the National 
                Health Board for further action the extent of 
                inappropriate care, including underservice and 
                overservice, and its consequences;
                    (iv) develop additional methods of quality 
                improvement for implementation by the National Health 
                Board and other entities, including systematic review 
                of patterns of practice that compromise the quality of 
                care and recommendations to redress such practices, 
                education for health care workers to improve the 
                quality of care, and guidelines for the optimal 
                organization of health services and the use of tertiary 
                care facilities;
                    (G) administer the periodic convening of the U.S. 
                Preventive Health Services Task Force, which shall 
                recommend to the National Health Board a schedule for 
                preventive health services based on age and sex, which 
                schedule shall reflect the most recent medical 
                evidence; and
                    (H) provide education for users on clinical 
                effectiveness guidelines and the most effective 
                preventive, diagnostic, and treatment practices.
            (3) National institute of health care services.--A National 
        Institute of Health Care Services, which shall--
                    (A) analyze data and statistics on the health care 
                resources and needs of the Nation and on the quality of 
                present services;
                    (B) conduct comparative studies of health care 
                services in the various regions of the Nation, and make 
                recommendations for the improvement of health care 
                services in areas with inferior quality of health care 
                services;
                    (C) plan and conduct research on alternative 
                methods of health care delivery, on the functions, 
                tasks, performance and work relationships of various 
                kinds and categories of health workers, on patterns of 
                organization of health care, and on the effectiveness 
                and benefits of health care in relation to costs; and
                    (D) assist the National Health Board in formulating 
                national policies to improve the quality of health care 
                services.
            (4) National institute of pharmacy and medical supply.--A 
        National Institute of Pharmacy and Medical Supply, which 
        shall--
                    (A) recommend to the National Health Board 
                standards regarding the quality, distribution, and 
                price of all drugs, therapeutic devices, appliances and 
                equipment to be used by the Service;
                    (B) certify drugs, therapeutic devices, appliances, 
                and equipment for use in the health facilities of the 
                Service, and for furnishing to users of such health 
                facilities;
                    (C) assist the National Health Board in issuing a 
                National Pharmacy and Medical Supply Formulary; and
                    (D) conduct a comprehensive program of 
                pharmaceutical and medical supply research and 
                utilization education using regional facilities to the 
                maximum extent possible
            (5) National institute of sociology of health and health 
        care.--A National Institute of Sociology of Health and Health 
        Care, which shall--
                    (A) conduct ongoing analyses of the basic 
                epistemological assumptions of health and health care;
                    (B) assess critically the effects of scientific 
                medicine and of divisions in institutional and 
                technical skills in health care;
                    (C) evaluate the effects of health care measures 
                and policies upon population groups and subgroups in 
                the Nation;
                    (D) identify and analyze the social, cultural, 
                economic, occupational, distributional, and 
                environmental factors in modern society affecting 
                health and well-being;
                    (E) analyze alternative, holistic approaches to the 
                human body, health, and causality of ill health and the 
                lack of social and psychological well-being; and
                    (F) assist the National Health Board in formulating 
                national policies relating to the promotion of health 
                and the provision of health care.
    (b) Coordination of Effort.--The National Health Board will 
establish mechanisms for internal coordination of research among the 
five Institutes, and will also coordinate effort with agencies under 
the Department of Health and Human Services, including the Food and 
Drug Administration and the Health Resources and Services 
Administration.

 Subtitle D--Health Planning, Distribution of Drugs and Other Medical 
                 Supplies, and Miscellaneous Functions

SEC. 431. HEALTH PLANNING AND BUDGETING.

    (a) In General.--The National Health Board shall develop and 
implement guidelines to collect data on the supply of and demand for 
health workers in facilities under its supervision, and on the delivery 
of health care and supplemental services in health care facilities 
under its supervision, shall evaluate such data in relation to the 
health care needs of their respective area, and shall transmit such 
data and evaluation as necessary for implementation, and shall make 
available such data and evaluations to residents of their respective 
area.
    (b) Coordination.--The National Health Board shall coordinate the 
planning and administration of the delivery of health care services, 
health worker education, and health research within regions, and shall 
facilitate the planning and administration of such programs.
    (c) Plans.--The National Health Board shall formulate a 1-year and 
5-year national health plan and budget, taking into account the 
regional budgets prepared in accordance with section 522.

SEC. 432. DISTRIBUTION OF DRUGS AND OTHER MEDICAL SUPPLIES.

    (a) National Formulary.--
            (1) Publication.--The National Health Board, shall, not 
        later than the effective date of health services, publish and 
        disseminate a National Pharmacy and Medical Supply Formulary 
        (in this section referred to as the ``Formulary'').
            (2) Contents.--The Formulary shall contain a listing of 
        drugs, therapeutic devices, appliances, equipment, and other 
        medical supplies (including eyeglasses, other visual aids, 
        hearing aids, and prosthetic devices) (in this section referred 
        to as ``drugs and other medical supplies''). For each item on 
        such listing the Formulary shall contain (A) the standards of 
        quality for the production of such item, (B) the medical 
        conditions for which the item is certified as effective for 
        purposes of the provision of health care services under this 
        Act, and (C) such other information on such item as the 
        National Health Board determines to be appropriate for the 
        effective and efficient delivery of health care services under 
        this Act.
            (3) Updating.--The National Health Board shall, at regular 
        intervals, update the contents of the Formulary and publish a 
        price list for items listed in the Formulary, which prices 
        shall reflect the actual costs of manufacture.
    (b) Drug Purchase Programs.--
            (1) In general.--The National Health Board shall establish 
        a program, in accordance with this subsection for the purchase 
        and distribution of drugs and other medical supplies for use in 
        health care facilities.
            (2) Pricing.--Such program shall provide for the purchase 
        of each drug or other medical supply item only (A) following 
        competitive bidding on such item or (B) based on the price 
        listed for such item in the price list published under 
        subsection (a)(3).
            (3) Generic distribution.--Such program shall provide for 
        the distribution and dispensing of drugs under their generic 
        names.
            (4) Generic names defined.--For purposes of paragraph (3), 
        the term ``generic names'' means the established names, as 
        defined in section 502(e)(2) of the Federal Food, Drug, and 
        Cosmetic Act (21 U.S.C. 352(e)(2)).
    (c) Authority To Manufacture.--The National Health Board is 
authorized to establish and operate drug and medical supply 
manufacturing facilities, if it determines that such operation will 
result in reduced expenditures by the Service.

SEC. 433. MISCELLANEOUS FUNCTIONS OF THE NATIONAL HEALTH BOARD.

    (a) Annual Report.--The appropriate National Health Board shall 
publish, not later than December 31 of each year, a report presenting 
and evaluating operations of the Service during the fiscal year ending 
in such year and surveying the future health needs of the Nation and 
plans the Board has for the Service to meet such needs.
    (b) Dissemination.--The National Health Board shall, not later than 
the effective date of health services, prepare and disseminate, for use 
by users, information about health and health services deemed essential 
to ensure users' active and informed participation in the health care 
system, including information that is culturally appropriate for each 
area's principal cultural and ethnic groupings, a comprehensive 
dictionary of terms used in health care records and services maintained 
or provided by the Service. Such dictionary shall explain terms related 
to symptoms, signs, diagnoses, etiologic agents and conditions, 
diagnostic procedures, and the treatment and prevention of, and 
rehabilitation following, illnesses, and shall include extensive 
citations of lay and professional sources which a user might consult 
for additional information on such terms.

                   TITLE V--FINANCING OF THE SERVICE

                    Subtitle A--Health Service Taxes

SEC. 501. INDIVIDUAL AND CORPORATE INCOME TAXES.

    (a) Health Service Taxes.--
            (1) In general.--Subchapter A of chapter 1 of the Internal 
        Revenue Code of 1986 (relating to normal taxes and surtaxes) is 
        amended by adding at the end the following new part:

                   ``PART VIII--HEALTH SERVICE TAXES

``Sec. 59B. Tax imposed.

``SEC. 59B. TAX IMPOSED.

    ``(a) Individuals, Estates, and Trusts.--In addition to other 
taxes, there is hereby imposed for each taxable year on the taxable 
income of every individual and of every estate and trust taxable under 
section 1(d), a tax in an amount equal to 10 percent of the total tax 
imposed by section 1 for such taxable year.
    ``(b) Corporation.--In addition to the other taxes, there is hereby 
imposed for each taxable year on the taxable income of every 
corporation, a tax in an amount equal to 90 percent of the total amount 
of the normal tax and surtax imposed by section 11 for such taxable 
year.''
            (2) Clerical amendment.--The table of parts of such 
        subchapter A is amended by adding after the item relating to 
        part VII the following new item:

                              ``Part VIII. Health service taxes.''.
    (b) Effective Date.--The amendments made in this section shall 
apply to taxable years beginning on or after the effective date of 
health services.

SEC. 502. OTHER CHANGES IN THE INTERNAL REVENUE CODE OF 1986.

    (a) Denial of Exclusion From Gross Income for Amounts Paid by Third 
Parties for Medical Care.--Section 105 of the Internal Revenue Code of 
1986 (relating to amounts received under accident and health plans) is 
amended by striking subsection (b).
    (b) Denial of Exclusion From Gross Income of Certain Contributions 
by the Employer to Health Plans.--Subsection (a) of section 106 of such 
Code (relating to contributions by employer to accident and health 
plans) is amended to read as follows:
    ``(a) General Rule.--Except as otherwise provided in this section, 
gross income does not include contributions by the employer to accident 
or health plans for compensation (through insurance or otherwise) to 
his employees for personal injuries or sickness to the extent that such 
contributions do not provide for health care and supplemental services 
available to such employees under the Josephine Butler United States 
Health Service Act.''
    (c) Denial of Deduction of Health Care Expenses as Trade or 
Business Expenses.--Section 162 of such Code (relating to trade or 
business expenses) is amended by redesignating subsection (p) as 
subsection (q) and by adding after subsection (o) the following new 
subsection:
    ``(p) Payments for Health Care.--No deduction shall be allowed 
under subsection (a) for any amount paid for health care services 
(other than any amount of tax imposed by section 59B and paid by the 
employer on behalf of his employees) which an individual was eligible 
to receive under title II of the Josephine Butler United States Health 
Service Act.''.
    (d) Denial of Deduction for Contributions to Certain Medical and 
Hospital Facilities.--
            (1) Paragraph (2) of section 170(c) of such Code (relating 
        to charitable, etc., contributions and gifts) is amended by 
        inserting ``(other than an organization described in subsection 
        (b)(1)(A)(iii))'' after ``(2) A corporation, trust, or 
        community chest, fund, or foundation''.
            (2) Subsection (e) of section 501 of such Code (relating to 
        cooperative hospital service organizations) is amended by 
        striking the last sentence.
    (e) Denial of Deduction for Medical, Dental, Etc., Expenses.--
            (1) Section 213 of such Code (relating to medical, dental, 
        etc., expenses) is repealed.
            (2) The table of sections of part VII of subchapter B of 
        chapter 1 of such Code is amended by striking the item relating 
        to section 213.
    (f) Hospital Insurance Tax.--
            (1) Subsection (b) of section 1401 of such Code (relating 
        to rate of tax on self-employment income) is repealed.
            (2) Subsection (b) of section 3101 of such Code (relating 
        to rate of tax on employees under the Federal Insurance 
        Contributions Act) is repealed.
            (3) Section 3201(a) of such Code (relating to rate of tax 
        imposed on employees under the Railroad Retirement Tax Act) is 
        amended by striking ``the sum of the rates of tax in effect 
        under subsections (a) and (b) of section 3101'' and inserting 
        ``the rate of tax in effect under section 3101(a)''.
            (4) Section 3211(a)(1) of such Code (relating to rate of 
        tax on employee representatives under the Railroad Retirement 
        Tax Act) is amended by striking ``subsections (a) and (b)'' the 
        first place it appears and inserting ``subsection (a)''.
            (5) Subsection (e) of section 6051 of such Code (relating 
        to railroad employees) is repealed.
    (g) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning on or after the effective date of 
health services.

SEC. 503. EXISTING EMPLOYER-EMPLOYEE HEALTH BENEFIT PLANS.

    No contractual or other nonstatutory obligation of any employer to 
pay for or provide any health care and supplemental service to his 
present and former employees and their dependents and survivors, or to 
any of such persons, shall apply on and after the effective date of 
health services to the extent such individuals are eligible to receive 
such health care and supplemental services under this Act.

SEC. 504. WORKERS COMPENSATION PROGRAMS.

    No workers compensation program, whether established pursuant to 
Federal or State law or private initiative, shall pay for or provide 
any health care and supplemental services on and after the effective 
date of health services, to the extent such health care and 
supplemental services are available under this Act.

                 Subtitle B--Health Service Trust Fund

SEC. 511. ESTABLISHMENT OF HEALTH SERVICE TRUST FUND.

    (a) Establishment.--There is hereby created on the books of the 
Treasury of the United States a trust fund to be known as the Health 
Service Trust Fund (in this title referred to as the ``Trust Fund''). 
The Trust Fund shall consist of such gifts and bequests as may be made 
to the Service and such amounts as may be deposited in, or appropriated 
to, such fund as provided in this subtitle.
    (b) Appropriation.--There is hereby appropriated to the Trust Fund 
for each fiscal year beginning in the fiscal year in which the 
effective date of health services (as defined in title VI) falls, and 
for each fiscal year thereafter, out of any moneys in the Treasury not 
otherwise appropriated, an amount equal to 100 percent of expected net 
receipts from the taxes imposed by sections 59B and 3111(b) of the 
Internal Revenue Code of 1986 (as estimated by the Secretary of the 
Treasury). The amount appropriated by the preceding sentence shall be 
transferred from time to time from the general fund in the Treasury to 
the Trust Fund in such smaller amounts to be determined on the basis of 
estimates by the Secretary of the Treasury of the receipts specified in 
the preceding sentence; and proper adjustments shall be made in the 
amounts subsequently transferred to the extent prior estimates were in 
excess of or were less than the receipts specified in such sentence.

SEC. 512. TRANSFER OF FUNDS TO THE HEALTH SERVICE TRUST FUND.

    (a) Of Medicare Trust Funds.--On the effective date of health 
services, there are transferred to the Trust Fund all of the assets and 
liabilities of the Federal Hospital Insurance Trust Fund and the 
Federal Supplementary Medical Insurance Trust Fund.
    (b) Additional Amounts.--In addition to the sums appropriated by 
section 511(b), there is appropriated to the Trust Fund for each fiscal 
year, out of any moneys in the Treasury not otherwise appropriated, a 
governmental contribution equal to 40 percent of the sums appropriated 
by section 511(b) for such fiscal year. There shall be deposited in the 
Trust Fund all recoveries of overpayments, and all receipts under loans 
or other agreements entered into, under this Act.

SEC. 513. ADMINISTRATION OF HEALTH SERVICE TRUST FUND.

    (a) Board of Trustees.--With respect to the Trust Fund, there is 
hereby created a body to be known as the Board of Trustees of the Trust 
Fund (in this section referred to as the ``Board of Trustees'') 
composed of the Secretary of the Treasury, the Secretary of Health and 
Human Services, and the Chairperson of the National Health Board, all 
ex officio. The Secretary of the Treasury shall be the Managing Trustee 
of the Board of Trustees (in this section referred to as the ``Managing 
Trustee''). The Chairperson of the National Health Board shall serve as 
the Secretary of the Board of Trustees. The Board of Trustees shall 
meet not less frequently than once each calendar year. It shall be the 
duty of the Board of Trustees to--
            (1) hold the Trust Fund;
            (2) report to the Congress not later than the first day of 
        April of each year on the operation and status of the Trust 
        Fund during the preceding fiscal year and on its expected 
        operation and status during the current fiscal year and the 
        next 2 fiscal years;
            (3) report immediately to the Congress whenever the Board 
        is of the opinion that the amount of the Trust Fund is unduly 
        small; and
            (4) review the general policies followed in managing the 
        Trust Fund, and recommend changes in such policies, including 
        necessary changes in the provisions of law which govern the way 
        in which the Trust Fund is to be managed.
The report provided for in paragraph (2) shall include a statement of 
the assets of, and the disbursements made from, the Trust Fund during 
the preceding fiscal year, an estimate of the expected income to, and 
disbursements to be made from, the Trust Fund during the current fiscal 
year and each of the next 2 fiscal years, and a statement of the 
actuarial status of the Trust Fund. Such report shall be printed as a 
House document of the session of the Congress to which the report is 
made.
    (b) Investment.--It shall be the duty of the Managing Trustee to 
invest such portion of the Trust Fund as is not, in his judgment, 
required to meet current withdrawals. Such investments may be made only 
in interest bearing obligations of the United States or in obligations 
guaranteed as to both principal and interest by the United States. For 
such purpose such obligations may be acquired (1) on original issue at 
the issue price, or (2) by purchase of outstanding obligations at the 
market price. The purposes for which obligations of the United States 
may be issued under the Second Liberty Bond Act, as amended, are hereby 
extended to authorize the issuance at par of public debt obligations 
for purchase by the Trust Fund.
    (c) Issuance of Obligations.--Any obligations acquired by the Trust 
Fund (except public debt obligations issued exclusively to the Trust 
Fund) may be sold by the Managing Trustee at the market price, and such 
public debt obligations may be redeemed at par plus accrued interest.
    (d) Payment of Interest.--The interest on, and the proceeds from 
the sale or redemption of, any obligations held in the Trust Fund shall 
be credited to and form a part of the Trust Fund.
    (e) Payments.--The Managing Trustee shall pay from time to time 
from the Trust Fund such amounts as the National Health Board certifies 
are necessary to carry out this Act.

              Subtitle C--Preparation of Plans and Budgets

SEC. 521. DETERMINATION OF FUND AVAILABILITY.

    (a) Maximum Funds.--
            (1) Fixing.--The National Health Board shall, not later 
        than January 1 of each year, initially fix the maximum amount 
        of funds which may (except as provided in subsection (c)) be 
        obligated during the fiscal year beginning on October 1 of such 
        year for expenditure from the Trust Fund.
            (2) Limitation.--Such amount shall not exceed for a fiscal 
        year the lesser of--
                    (A) 140 percent of the expected net receipts during 
                the fiscal year (as estimated by the Secretary of the 
                Treasury) from the taxes imposed by sections 59 and 
                3111(b) of the Internal Revenue Code of 1986;
                    (B) the amount of the aggregate obligations that 
                the National Health Board determines were (or will be) 
                incurred by the Service from the Trust Fund during the 
                previous fiscal year, adjusted to reflect changes 
in the cost of living, in the number of users, and in the capacity of 
the Service to provide services under this Act. (C) the amount fixed 
under subsection (b).
            (3) Refixing.--The National Health Board may at any time 
        refix such amount to reflect changes--
                    (A) of one percent or more in the expected net tax 
                receipts (described in paragraph (2)(A)); or
                    (B) of five percent or more in the cost of living, 
                number of users, or the capacity of the Service to 
                provide services under this Act.
        The National Health Board shall promptly report to Congress any 
        increase made in such amount and the reasons therefor.
    (b) Lesser Amount.--The National Health Board shall fix in a fiscal 
year an amount, which the maximum amount described in subsection (a)(1) 
may not exceed in the fiscal year, which is less than the amount 
described in subsection (a)(2)(A) if the Board determines that--
            (1) restriction of the amount to be made available for 
        obligation will not materially impair the adequacy or quality 
        of health care and supplemental services provided to users, or
            (2) improvement in the organization, delivery, or 
        utilization of such services has lessened their aggregate cost 
        (or increase in such cost).
    (c) Obligation.--The National Health Board may obligate for 
expenditure from the Trust Fund, in addition to the maximum amount 
which may be obligated in a fiscal year under subsection (a), such 
funds as are necessary to provide health care and supplemental services 
needed because of an epidemic, disaster, or other occurrence which was 
not, and could not have been, reasonably planned for by the Board and 
for which the contingency fund provided in section 532(b)(7) is 
insufficient. The National Health Board shall promptly report to 
Congress any obligation made pursuant to this subsection and the 
reasons therefor.
    (d) Obligation of Borrowed Amounts.--In addition to the maximum 
amounts which may be obligated pursuant to subsection (a), the National 
Health Board may allocate funds borrowed in accordance with section 541 
for such purposes as it deems necessary and appropriate.

SEC. 522. PREPARATION OF REGIONAL BUDGETS.

    (a) Population Need.--In preparing its annual budget the National 
Health Board, in coordination with its local and regional authorities, 
shall determine the projected per capita health expenditures for each 
region, based on the evaluation of health care needs described in this 
Act.
    (b) Budget Breakdowns.--In preparing its annual budget the National 
Health Board shall specify its operating, prevention, capital, and 
research expenses anticipated for the fiscal year covered by the budget 
and for the 5-year period beginning with such fiscal year for each such 
region.

            Subtitle D--Allocation and Distribution of Funds

SEC. 531. NATIONAL BUDGET.

    (a) Preparation.--The National Health Board shall prepare, taking 
into consideration the budgets prepared under section 522, as soon 
after April 1 of each year as is practicable, a national health budget 
for the fiscal year beginning on October 1 of such year. Such budget 
shall divide the total funds available for obligation in such year, as 
determined under section 521, into funds for--
            (1) ordinary operating expenses;
            (2) preventive health measures, and which measures shall 
        include primary prevention to improve the conditions under 
        which people live that affect health status;
            (3) capital expenses;
            (4) research expenses; and
            (5) special operating expenses, as described in section 
        532.
    (b) Ordinary Operating Expenses.--Funds for ordinary operating 
expenses, for preventive health measures, and for research expenses 
shall be divided among regions in the proportion which the number of 
residents in each region bears to the total population of the Nation, 
adjusted for population need as defined in this Act.
    (c) Capital Expenses.--Funds for capital expenses shall be 
allocated, to the extent consistent with the efficient and equitable 
use of resources, except that during the first 10 fiscal years 
following the effective date of health services, priority shall be 
given to regions lacking adequate health care facilities on such 
effective date.

SEC. 532. SPECIAL OPERATING EXPENSE FUND.

    (a) In General.--A fund for special operating expenses shall be 
incorporated into each budget prepared by the National Health Board. 
For the purposes of this title, the term ``special operating expenses'' 
means operating expenses associated with--
            (1) the care and treatment of users 65 years of age or 
        older;
            (2) the care and treatment of persons confined to full-time 
        residential care institutions, including nursing homes and 
        facilities for the treatment of mental illness;
            (3) the special health care needs of low-income users;
            (4) the special health care needs of communities of color 
        that experience disparities in health status compared to white 
        populations;
            (5) the special health care needs of residents of rural or 
        frontier areas, or noncontiguous States and territories;
            (6) special health care needs arising from environmental or 
        occupational health conditions;
            (7) special health care needs arising from unexpected 
        occurrences, including epidemics and natural disasters; and
            (8) the conduct of environmental health inspection and 
        monitoring services.
    (b) Allocation.--The special operating expense fund shall be 
allocated as follows:
            (1) Funds for the additional operating expenses associated 
        with the care and treatment of users 65 years of age or older 
shall be allocated and shall consist of uniform basic capitation 
amounts multiplied by the number of residents 65 years of age or older 
in the respective areas. The basic capitation amounts for areas shall 
be determined by the National Health Board, based upon studies of the 
additional operating expenses associated with the care and treatment of 
such residents in such areas.
            (2) Funds for the additional operating expenses associated 
        with the care and treatment of persons confined to full-time 
        residential care institutions shall be allocated and shall 
        consist of a uniform basic capitation amount for each kind of 
        institution, multiplied by the number of residents in such 
        institutions in the respective areas. The basic capitation 
        amounts shall be determined by the National Health Board, based 
        upon studies of the additional operating expenses associated 
        with the care and treatment of such persons and the maintenance 
        of such institutions.
            (3) Funds shall be allocated to areas for the additional 
        operating expenses associated with the special health care 
        needs of low-income persons. Such payments shall be allocated 
        in proportion to the number of residents in these areas having 
        incomes below the poverty level (as defined by the Secretary of 
        Commerce). The total funds allocated for this purpose shall be 
        no less than 2 percent of the ordinary operating expense funds 
        allocated in accordance with section 531(a).
            (4) Funds shall be allocated for the additional operating 
        expenses associated with the special health care needs of 
        communities of color to the extent that they experience 
        disparities in health status compared to white populations. The 
        basic capitation amounts shall be determined by the National 
        Health Board, based upon studies of the additional operating 
        expenses associated with providing the necessary or appropriate 
        health services for communities of color, and the additional 
        expenses associated with eliminating such disparities in health 
        status.
            (5) Funds for the additional operating expenses associated 
        with the special health care needs of residents of rural or 
        frontier areas, or noncontiguous States and territories, shall 
        be allocated to communities serving areas of low population 
        density and shall consist of basic capitation amounts 
        multiplied by the number of residents in the respective areas. 
        The basic capitation amounts shall be determined by the 
        National Health Board based upon studies of the additional 
        operating expenses associated with the provision of health care 
        in areas of low population density or extreme geographic access 
        barriers, or both.
            (6) Funds for the additional operating expenses associated 
        with special regional health care needs arising from 
        environmental and occupational health problems shall be 
        allocated by the National Health Board in accordance with its 
        determination of such special needs. The total funds allocated 
        for this purpose shall be no greater than \1/2\ of 1 percent of 
        the ordinary operating expense funds allocated in accordance 
        with section 531(a).
            (7) Funds for the additional operating expenses associated 
        with special health care needs arising from unexpected 
        occurrences shall be retained by the National Health Board in a 
        contingency fund and shall be allocated by the National Health 
        Board in accordance with its determination of such needs. The 
        total funds retained for this purpose in any one fiscal year 
        shall be no greater than \1/2\ of 1 percent of the ordinary 
        operating expense funds allocated in such year in accordance 
        with section 531(a).
            (8) Funds for the additional operating expenses associated 
        with the conduct of environmental health inspection and 
        monitoring services shall be allocated by the National Health 
        Board for providing such services.

SEC. 533. DISTRIBUTION OF FUNDS.

    (a) In General.--Funds allocated under the national health budget 
shall be distributed by the National Health Board from the Trust Fund. 
Participating providers may not request or receive funds from any other 
source.
    (b) Payments and Expenditures.--All payments shall be expended in 
accordance with the budget adopted under section 531. If the budget for 
any fiscal year is not adopted before the beginning of the fiscal year, 
until such budget is adopted the National Health Service shall continue 
to receive ordinary operating expense funds, prevention expense funds, 
and research expense funds at the rate at which it was receiving such 
funds during the preceding fiscal year, and it shall receive special 
operating expense funds in accordance with section 532.
    (c) Accounts.--The National Health Board shall maintain separate 
accounts for--
            (1) funds for operating expenses, including ordinary 
        operating expenses and special operating expenses;
            (2) funds for preventive health measures;
            (3) funds for capital expenses; and
            (4) funds for research expenses.
Funds in a capital expense account shall be expended only for capital 
expenses. Funds in a research expense account shall be expended only 
for operations, equipment, and facilities for health and health care 
delivery research conducted in accordance with subtitle C of title IV. 
Separate accounts shall not be required for funds for ordinary 
operating expenses and for special operating expenses.
    (d) Payment Frequency.--Service providers under this Act shall be 
paid at such time or times as the National Health Board finds 
appropriate.
    (e) Allocation of Supplementary Payments.--Before and during any 
fiscal year, supplementary funds may be allocated to any Service 
provider if the National Health Board finds that such funds are 
required by events occurring or information acquired after the initial 
allocations were made.
    (f) Use of Funds.--Service providers may retain funds received from 
the National Health Board for 2 years following the receipt of such 
funds. Any funds which are unexpended after such time shall be returned 
to the National Health Board for deposit in the Trust Fund.

SEC. 534. ANNUAL STATEMENT, RECORDS, AND AUDITS.

    (a) Annual Statement.--Each Service provider shall prepare annually 
and transmit to the National Health Board a statement which shall 
accurately show its financial operations and for the year for which 
such statement is prepared.
    (b) Recordkeeping.--Each Service provider shall keep such records 
as determined to be necessary for the purposes of this Act, including 
for the facilitation of audits.
    (c) Audits.--The National Health Board and the Comptroller General 
of the United States, or their duly authorized representatives, shall, 
for the purpose of audits, have access to any books, documents, papers, 
and records which in their opinion are related or pertinent to the 
operation of the Service.

                     Subtitle E--General Provisions

SEC. 541. ISSUANCE OF OBLIGATIONS.

    (a) Borrowing Authority.--The National Health Board is authorized 
to borrow money and to issue and sell such obligations as it determines 
necessary to carry out the purposes of this Act, but only in such 
amounts as may be specified from time to time in appropriation Acts. 
The aggregate amount of any such obligations outstanding at any one 
time shall not exceed $10,000,000,000.
    (b) Pledging of Assets.--The National Health Board may pledge the 
assets of the Trust Fund and pledge and use its revenues and receipts 
for the payment of the principal of or interest on such obligations, 
for the purchase or redemption thereof, and for other purposes 
incidental thereto. The National Health Board is authorized to enter 
into binding covenants with the holders of such obligations, and with 
the trustee, if any, under any agreement entered into in connection 
with the issuance thereof with respect to the establishment of reserve, 
sinking, and other funds, stipulations concerning the issuance of 
obligations or the execution of leases or lease purchases relating to 
properties of the Service and such other matters as the National Health 
Board deems necessary or desirable to enhance the marketability of such 
obligations.
    (c) Form of Obligations.--Obligations issued by the Service under 
this section--
            (1) shall be in such forms and denominations;
            (2) shall be sold at such times and in such amounts;
            (3) shall mature at such time or times;
            (4) shall be sold at such prices;
            (5) shall bear such rates of interest;
            (6) may be redeemable before maturity in such manner, at 
        such times, and at such redemption premiums;
            (7) may be entitled to such relative priorities of claim on 
        the assets of the Service with respect to principal and 
        interest payments; and
            (8) shall be subject to other terms and conditions, as the 
        National Health Board determines.
    (d) Character of Obligations.--Obligations issued by the Service 
under this section shall--
            (1) be negotiable or nonnegotiable and bearer or registered 
        instruments, as specified therein and in any indenture or 
        covenant relating thereto;
            (2) contain a recital that they are issued under this 
        section, and such recital shall be conclusive evidence of the 
        regularity of the issuance and sale of such obligations and of 
        their validity;
            (3) be lawful investments and may be accepted as security 
        for all fiduciary, trust, and public funds, the investment or 
        deposit of which shall be under the authority or control of any 
        officer or agency of the Government of the United States, and 
        the Secretary of the Treasury or any other officer or agency 
        having authority over or control of any such fiduciary, trust, 
        or public funds, may at any time sell any of the obligations of 
        the Service acquired under this section;
            (4) be exempt both as to principal and interest from all 
        taxation now or hereafter imposed by any State or local taxing 
        authority except estate, inheritance, and gift taxes; and
            (5) not be obligations of, nor shall payment of the 
        principal thereof or interest thereon be guaranteed by, the 
        Government of the United States, except as provided in 
        subsection (g).
    (e) Consultation With Treasury.--At least 15 days before selling 
any issue of obligations, the National Health Board shall advise the 
Secretary of the Treasury of the amount, proposed date of sale, 
maturities, terms and conditions, and expected maximum rates of 
interest of the proposed issue in appropriate detail and shall consult 
with him or his designee thereon. The Secretary may elect to purchase 
such obligations under such terms, including rates of interest, as he 
and the National Health Board may agree, but at a rate of yield no less 
than the prevailing yield on outstanding marketable Treasury securities 
of comparable maturity, as determined by the Secretary. If the 
Secretary does not purchase such obligations, the National Health Board 
may proceed to issue and sell them to a party or parties other than the 
Secretary upon notice to the Secretary and upon consultation as to the 
date of issuance, maximum rates of interest, and other terms and 
conditions.
    (f) Purchase of Obligations.--Subject to the conditions of 
subsection (e), the National Health Board may require the Secretary of 
the Treasury to purchase obligations of the Service in such amounts as 
will not cause the holding by the Secretary of the Treasury resulting 
from such required purchases to exceed $2,000,000,000 at any one time. 
This subsection shall not be construed as limiting the authority of the 
Secretary to purchase obligations of the Service in excess of such 
amount.
    (g) Full Faith and Credit.--Notwithstanding subsection (d)(5), 
obligations issued by the Service shall be obligations of the 
Government of the United States, and payment of principal and interest 
thereon shall be fully guaranteed by the Government of the United 
States, such guaranty being expressed on the face thereof, if and to 
the extent that--
            (1) the National Health Board requests the Secretary of the 
        Treasury to pledge the full faith and credit of the Government 
        of the United States for the payment of principal and interest 
        thereon; and
            (2) the Secretary, in his discretion, determines that it 
        would be in the public interest to do so.
    (h) Public Debt Transaction.--For the purpose of any purchase of 
the obligations of the Service, the Secretary of the Treasury is 
authorized to use as a public debt transaction the proceeds from the 
sale of any securities issued under the Second Liberty Bond Act, as now 
or hereafter in force, and the purposes for which securities may be 
issued under the Second Liberty Bond Act, as now or hereafter in force, 
are extended to include any purchases of the obligations of the Service 
under this subtitle. The Secretary of the Treasury may, at any time, 
sell any of the obligations of the Service acquired by him under this 
chapter. All redemptions, purchases, and sales by the Secretary of the 
obligations of the Service shall be treated as public debt transactions 
of the United States.

SEC. 542. DEFINITIONS.

    For purposes of this title:
            (1) Operating expenses.--The term ``operating expenses'' 
        means the cost of providing, planning, operating, and 
        maintaining services, facilities, programs, and boards (other 
        than those associated with research) established or furnished 
        under this Act, and of capital buildings and equipment (other 
        than those associated with research) costing less than 
        $100,000, except for funds associated with the conduct of 
        preventive health measures and research.
            (2) Capital expenses.--The term ``capital expenses'' means 
        expenses which under generally accepted accounting principles 
        are not properly chargeable as expenses of operation and 
        maintenance, which exceed $100,000, and which are not 
        associated primarily with the conduct of research.

                   TITLE VI--MISCELLANEOUS PROVISIONS

SEC. 601. EFFECTIVE DATE OF HEALTH SERVICES.

    The effective date of health services under this Act is January 1 
of the fourth calendar year after the year in which this Act is 
enacted.

SEC. 602. REPEAL OF PROVISIONS.

    (a) In General.--Effective on the effective date of health 
services, the following provisions of law are repealed:
            (1) The Public Health Service Act, except for--
                    (A) title I (relating to short title and 
                definitions), parts F and G of title III (relating to 
                licensing and quarantine authority), and title XIV 
                (relating to safety of public water systems); and
                    (B) titles VII and VIII, which shall remain 
                effective, during the period beginning on such 
                effective date and ending on the date occurring 4 years 
                after such effective date, with respect to the 
                provision of assistance to educational institutions, 
                and students thereof, in areas which have not 
                established health team schools under subtitle A of 
                title III of this Act.
            (2) Titles V, XVIII, XIX, and XXI of the Social Security 
        Act (relating to the maternal and child health and crippled 
        children's services, Medicare, Medicaid, and State children's 
        health insurance program); part B of title XI of such Act 
        (relating to professional standards review); sections 226, 1121 
        through 1124, and 1126 of such Act (relating to entitlement to 
        hospital insurance benefits, uniform health reporting systems, 
        limitation on Federal participation for capital expenditures, 
        program for determining qualification for certain health care 
        personnel, disclosure of ownership and related information, and 
        disclosure of certain convictions); and so much of title XX of 
        such Act (relating to grants to States for services) as 
        provides for payments to States for health care and 
        supplemental services.
            (3) Chapter 89 of title 5, United States Code (relating to 
        health insurance for Federal employees).
            (4) Chapters 17, 73, and 81 and section 1506 of title 38, 
        United States Code (relating to medical benefits and programs 
        relating to veterans).
            (5) Sections 1079 through 1083 and section 1086 of title 
        10, United States Code (relating to the civilian health and 
        medical program of the uniformed services).
            (6) The Comprehensive Alcohol Abuse and Alcoholism 
        Prevention, Treatment, and Rehabilitation Act of 1970; the 
        Comprehensive Alcohol Abuse and Alcoholism Prevention, 
        Treatment, and Rehabilitation Act Amendments of 1974; and 
        section 4 of the Comprehensive Drug Abuse Prevention and 
        Control Act of 1970 (relating to medical treatment of narcotic 
        addiction).
            (7) Public Law 83-568 (42 U.S.C. 2001-2004b) (relating to 
        hospital and other health facilities for Indians) and Public 
        Law 85-151 (42 U.S.C. 2005-2005f) (relating to community 
        hospitals for Indians).
            (8) The District of Columbia Medical Facilities 
        Construction Act of 1968 and the District of Columbia Medical 
        and Dental Manpower Act of 1970.
            (9) Sections 232 and 242 and title XI of the National 
        Housing Act (relating to mortgage insurance for nursing homes, 
        hospitals, and group practice facilities).
            (10) The Mental Retardation Facilities and Community Mental 
        Health Centers Construction Act of 1963.
            (11) The Family Planning Services and Population Research 
        Act of 1970.
            (12) The National Arthritis Act of 1974 and the National 
        Diabetes Mellitus Research and Education Act.
            (13) Titles I and II and section 301 of the Lead-Based 
        Paint Poisoning Prevention Act (42 U.S.C. 4801, 4811, 4821) 
        (relating to grant programs for lead-based paint poisoning 
        prevention).
            (14) The Act of March 2, 1897 (21 U.S.C. 41-50) (relating 
        to tea importation).
            (15) Subsection (e) of section 20 and section 22 of the 
        Occupational Safety and Health Act of 1970 (relating to the 
        National Institute for Occupational Safety and Health).
    (b) Preparation of Additional List.--
            (1) In general.--Not later than three years after the date 
        of enactment of this Act, the President shall prepare, in 
        consultation with the appropriate National Health Board, and 
        transmit to Congress legislation--
                    (A) to repeal or amend such provisions of law as 
                are inconsistent with the purposes of this Act or the 
                provision of health care and supplemental services by 
                the Service under this Act; and
                    (B) to make such conforming and technical 
                amendments in provisions of law as may be necessary to 
                properly effect the repeal of provisions described in 
                subsection (a) and the repeal or amendment of 
                provisions described in subparagraph (A) of this 
                paragraph.
            (2) Transfer authority.--Such legislation shall include the 
        transfers of such authority of the Secretary of Health and 
        Human Services under the provisions of--
                    (A) the Controlled Substances Act;
                    (B) chapter 175 of title 28, United States Code 
                (relating to civil commitment and rehabilitation of 
                narcotics addicts);
                    (C) chapter 314 of title 18, United States Code 
                (relating to sentencing of narcotic addicts to 
                commitment for treatment);
                    (D) the Narcotic Addict Rehabilitation Act of 1966;
                    (E) the Drug Abuse Office and Treatment Act of 
                1972;
                    (F) the Occupational Safety and Health Act of 1970;
                    (G) the Lead-Based Paint Poisoning Prevention Act;
                    (H) the Federal Cigarette Labeling and Advertising 
                Act;
                    (I) the Federal Food, Drug, and Cosmetic Act;
                    (J) the Fair Packaging and Labeling Act;
                    (K) the Act of March 4, 1923 (21 U.S.C. 61-64) 
                (relating to filled milk);
                    (L) the Act of February 15, 1927 (21 U.S.C. 141-
                149) (relating to milk importation);
                    (M) the Federal Caustic Poison Act;
                    (N) the Federal Coal Mine Health and Safety Act of 
                1969 (other than title IV thereof); and
                    (O) the Solid Waste Disposal Act,
        to the Service as the President determines, after consultation 
        with the National Health Board, to be appropriate.
    (c) Review of Programs.--
            (1) In general.--The National Health Board shall, 
        immediately upon its initial appointment, and in consultation 
        with the Secretary of Health and Human Services, review the 
        programs conducted under the specified provisions of the Public 
        Health Service Act and the other Acts described in subsection 
        (a) and shall determine how the Service shall carry out the 
        purposes of such programs.
            (2) Initial report.--Not later than one year after the 
        effective date of health services, the National Health Board 
        shall report to the President and to the Congress on how the 
        Service is carrying out the purposes of the programs authorized 
        to be conducted under provisions of law which are repealed by 
        subsection (a) (other than paragraph (1)(B) thereof).
            (3) Later report.--Not later than 5 years after the 
        effective date of health services, the National Health Board 
        shall report to the President and to the Congress on how the 
        Service is carrying out the purposes of programs described in 
        subsection (a)(1)(B).
    (d) Codification Proposal.--Not later than 2 years after the 
effective date of health services, the National Health Board shall 
transmit to Congress a proposed codification of all the provisions of 
law which contain functions that are transferred or relate to the 
Service.

SEC. 603. TRANSITION PROVISIONS.

    (a) Transfer of Appropriations.--Amounts appropriated to carry out 
the purposes of any provisions of law repealed by this Act and 
available on the effective date of such repeal shall be transferred on 
such date to the Health Service Trust Fund (established under section 
511 of this Act).
    (b) Transfer of Personnel, Assets, Etc.--The President is 
authorized to transfer so much of the positions, personnel, assets, 
liabilities, contracts, property, and records employed, held, used, 
arising from, available to or made available in connection with the 
functions or programs repealed by this Act to the Service as may be 
agreed upon by the President and the National Health Board.
    (c) Lapses of Offices.--In the case where the authority for the 
establishment of any office or agency, or all the functions of such 
office or agency, are repealed under section 602, such office or agency 
shall lapse.
    (d) Application of Amendments.--The amendments made by section 
602--
            (1) shall not apply with respect to any contract entered 
        into before the effective date of such amendments, and
            (2) shall not affect (A) any right or obligation arising 
        out of any matter occurring before the effective date of such 
        amendments, or (B) any administrative or judicial proceeding 
        (whether or not initiated before that date) for the 
        adjudication or enforcement of any such right or obligation.

SEC. 604. AMENDMENT TO BUDGET AND ACCOUNTING ACT.

    (a) Health Service Budget.--Section 1105 of title 31, United States 
Code, is amended by adding at the end the following new subsection:
    ``(h) The Budget transmitted pursuant to subsection (a) shall set 
forth the items enumerated in paragraphs (4) through (9) and (12) of 
subsection (a) with respect to expenditures from and appropriations to 
the Health Service Trust Fund (established under section 511 of the 
Josephine Butler United States Health Service Act) separately from such 
items with respect to expenditures and appropriations relating to other 
operations of the Government.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply with respect to fiscal years beginning more than 1 year after the 
date of enactment of this Act.

SEC. 605. SEPARABILITY.

    If any provision of this Act, or the application of such provision 
to any person or circumstance, shall be held invalid, the remainder of 
this Act, or the application of such provision to persons or 
circumstances other than those as to which it is held invalid, shall 
not be affected thereby.
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