[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 676 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 676
To provide for comprehensive health insurance coverage for all United
States residents, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 11, 2003
Mr. Conyers (for himself, Mr. McDermott, Mr. Kucinich, Mrs.
Christensen, Mr. Scott of Virginia, Ms. Lee, Ms. Norton, Mr. Davis of
Illinois, Mr. Owens, Mr. Jackson of Illinois, Mr. Hinchey, Mr. Payne,
Mr. Cummings, Ms. Kilpatrick, Mr. Hastings of Florida, Mr. Fattah, Mr.
Grijalva, Mr. Towns, Mr. Lewis of Georgia, Mr. Gutierrez, Mr. Thompson
of Mississippi, Ms. Carson of Indiana, Mr. Pastor, Ms. Woolsey, Mr.
Clay, and Mr. Rangel) introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the
Committees on Ways and Means, Resources, and Veterans' Affairs, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To provide for comprehensive health insurance coverage for all United
States residents, and for other purposes.
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 ``United States
National Health Insurance Act (or the Expanded and Improved Medicare
for All Act)''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions and terms.
TITLE I--ELIGIBILITY AND BENEFITS
Sec. 101. Eligibility and registration.
Sec. 102. Benefits and portability.
Sec. 103. Qualification of participating providers.
Sec. 104. Prohibition against duplicating coverage.
TITLE II--FINANCES
Subtitle A--Budgeting and Payments
Sec. 201. Budgeting process.
Sec. 202. Payment of providers and health care clinicians.
Sec. 203. Payment for long-term care.
Sec. 204. Mental health services.
Sec. 205. Payment for prescription medications, medical supplies, and
medically necessary assistive equipment.
Sec. 206. Consultation in establishing reimbursement levels.
Subtitle B--Funding
Sec. 211. Overview: funding the USNHI Program.
Sec. 212. Appropriations for existing programs for uninsured and
indigent.
TITLE III--ADMINISTRATION
Sec. 301. Public administration; appointment of Director.
Sec. 302. Quality and cost control.
Sec. 303. Regional and State administration; employment of displaced
clerical workers.
Sec. 304. Confidential Electronic Patient Record System.
Sec. 305. National Board of Universal Quality and Access.
TITLE IV--ADDITIONAL PROVISIONS
Sec. 401. Treatment of VA and IHS health programs.
Sec. 402. Public health and prevention.
Sec. 403. Reduction in health disparities.
TITLE V--EFFECTIVE DATE
Sec. 501. Effective date.
SEC. 2. DEFINITIONS AND TERMS.
In this Act:
(1) USNHI program; program.--The terms ``USNHI Program''
and ``Program'' mean the program of benefits provided under
this Act and, unless the context otherwise requires, the
Secretary with respect to functions relating to carrying out
such program.
(2) National board of universal quality and access.--The
term ``National Board of Universal Quality and Access'' means
such Board established under section 305.
(3) Regional office.--The term ``regional office'' means a
regional office established under section 303.
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(5) Director.--The term ``Director'' means, in relation to
the Program, the Director appointed under section 301.
TITLE I--ELIGIBILITY AND BENEFITS
SEC. 101. ELIGIBILITY AND REGISTRATION.
(a) In General.--All individuals residing in the United States
(including any territory of the United States) are covered under the
USNHI Program entitling them to a universal, best quality standard of
care. Each such individual shall receive a card with a unique number in
the mail. An individual's social security number shall not be used for
purposes of registration under this section.
(b) Registration.--Individuals and families shall receive a United
States National Health Insurance Card in the mail, after filling out a
United States National Health Insurance application form at a health
care provider. Such application form shall be no more than 2 pages
long.
(c) Presumption.--Individuals who present themselves for covered
services from a participating provider shall be presumed to be eligible
for benefits under this Act, but shall complete an application for
benefits in order to receive a United States National Health Insurance
Card and have payment made for such benefits.
SEC. 102. BENEFITS AND PORTABILITY.
(a) In General.--The health insurance benefits under this Act cover
all medically necessary services, including--
(1) primary care and prevention;
(2) inpatient care;
(3) outpatient care;
(4) emergency care;
(5) prescription drugs;
(6) durable medical equipment;
(7) long term care;
(8) mental health services;
(9) the full scope of dental services (other than cosmetic
dentistry);
(10) substance abuse treatment services;
(11) chiropractic services; and
(12) basic vision care and vision correction (other than
laser vision correction for cosmetic purposes).
(b) Portability.--Such benefits are available through any licensed
health care clinician anywhere in the United States that is legally
qualified to provide the benefits.
(c) No Cost-Sharing.--No deductibles, copayments, coinsurance, or
other cost-sharing shall be imposed with respect to covered benefits.
SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.
(a) Requirement To Be Public or Non-Profit.--
(1) In general.--No institution may be a participating
provider unless it is a public or not-for-profit institution.
(2) Conversion of investor-owned providers.--Investor-owned
providers of care opting to participate shall be required to
convert to not-for-profit status.
(3) Compensation for conversion.--The owners of such
investor-owned providers shall be compensated for the actual
appraised value of converted facilities used in the delivery of
care.
(4) Funding.--There are authorized to be appropriated from
the Treasury such sums as are necessary to compensate investor-
owned providers as provided for under paragraph (3).
(5) Requirements.--The conversion to a not-for-profit
health care system shall take place over a 15-year period,
through the sale of US Treasury Bonds. Payment for conversions
under paragraph (3) shall not be made for loss of business
profits, but may be made only for costs associated with the
conversion of real property and equipment.
(b) Quality Standards.--
(1) In general.--Health care delivery facilities must meet
regional and State quality and licensing guidelines as a
condition of participation under such program, including
guidelines regarding safe staffing and quality of care.
(2) Licensure requirements.--Participating clinicians must
be licensed in their State of practice and meet the quality
standards for their area of care. No clinician whose license is
under suspension or who is under disciplinary action in any
State may be a participating provider.
(c) Participation of Health Maintenance Organizations.--
(1) In general.--Non-profit health maintenance
organizations that actually deliver care in their own
facilities and employ clinicians on a salaried basis may
participate in the program and receive global budgets or
capitation payments as specified in section 202.
(2) Exclusion of certain health maintenance
organizations.--Other health maintenance organizations,
including those which principally contract to pay for services
delivered by non-employees, shall be classified as insurance
plans. Such organizations shall not be participating providers,
and are subject to the regulations promulgated by reason of
section 104(a) (relating to prohibition against duplicating
coverage).
(d) Freedom of Choice.--Patients shall have free choice of
participating physicians and other clinicians, hospitals, and inpatient
care facilities.
SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE.
(a) In General.--It is unlawful for a private health insurer to
sell health insurance coverage that duplicates the benefits provided
under this Act.
(b) Construction.--Nothing in this Act shall be construed as
prohibiting the sale of health insurance coverage for any additional
benefits not covered by this Act, such as for cosmetic surgery or other
services and items that are not medically necessary.
TITLE II--FINANCES
Subtitle A--Budgeting and Payments
SEC. 201. BUDGETING PROCESS.
(a) Establishment of Operating Budget and Capital Expenditures
Budget.--
(1) In general.--To carry out this Act there are
established on an annual basis consistent with this title--
(A) an operating budget;
(B) a capital expenditures budget;
(C) reimbursement levels for providers consistent
with subtitle B; and
(D) a health professional education budget,
including amounts for the continued funding of resident
physician training programs.
(2) Regional allocation.--After Congress appropriates
amounts for the annual budget for the USNHI Program, the
Director shall provide the regional offices with an annual
funding allotment to cover the costs of each region's
expenditures. Such allotment shall cover global budgets,
reimbursements to clinicians, and capital expenditures.
Regional offices may receive additional funds from the national
program at the discretion of the Director.
(b) Operating Budget.--The operating budget shall be used for--
(1) payment for services rendered by physicians and other
clinicians;
(2) global budgets for institutional providers;
(3) capitation payments for capitated groups; and
(4) administration of the Program.
(c) Capital Expenditures Budget.--The capital expenditures budget
shall be used for funds needed for--
(1) the construction or renovation of health facilities;
and
(2) for major equipment purchases.
(d) Prohibition Against Co-Mingling Operations and Capital
Improvement Funds.--It is prohibited to use funds under this Act that
are earmarked--
(1) for operations for capital expenditures; or
(2) for capital expenditures for operations.
SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLINICIANS.
(a) Establishing Global Budgets; Monthly Lump Sum.--
(1) In general.--The USNHI Program, through its regional
offices, shall pay each hospital, nursing home, community or
migrant health center, home care agencies, or other
institutional provider or pre-paid group practice a monthly
lump sum to cover all operating expenses under a global budget.
(2) Establishment of global budgets.--The global budget of
a provider shall be set through negotiations between providers
and regional directors, but are subject to the approval of the
Director. The budget shall be negotiated annually, based on
past expenditures, projected changes in levels of services,
wages and input, costs, and proposed new and innovative
programs.
(b) Three Payment Options for Physicians and Certain Other Health
Professionals.--
(1) In general.--The Program shall pay physicians,
dentists, doctors of osteopathy, psychologists, chiropractors,
doctors of optometry, nurse practitioners, nurse midwives,
physicians' assistants, and other advanced practice clinicians as
licensed and regulated by the States by the following payment methods:
(A) Fee for service payment under paragraph (2).
(B) Salaried positions in institutions receiving
global budgets under paragraph (3).
(C) Salaried positions within group practices or
non-profit health maintenance organizations receiving
capitation payments under paragraph (4).
(2) Fee for service.--
(A) In general.--The Program shall negotiate a
simplified fee schedule with clinician representatives,
after close consultation with the National Board of
Universal Quality and Access and regional and State
directors.
(B) Considerations.--In establishing such schedule,
the Director shall take into consideration regional
differences in reimbursement, but strive for a uniform
national standard.
(C) Final guidelines.--The regional directors shall
be responsible for promulgating final guidelines to all
providers.
(D) Billing.--Under the Act physicians shall submit
bills to the regional director on a simple form, or via
computer. Interest shall be paid to providers whose
bills are not paid within 30 days of submission.
(E) No balance billing.--Licensed health care
clinicians who accept any payment from the USNHI
Program may not bill any patient for any covered
service.
(F) Uniform computer electronic billing system.--
The Director shall make a good faith effort to create a
uniform computerized electronic billing system,
including in those areas of the United States where
electronic billing is not yet established.
(3) Salaries within institutions receiving global
budgets.--
(A) In general.--In the case of an institution,
such as a hospital, health center, group practice,
community and migrant health center, or a home care
agency that elects to be paid a monthly global budget
for the delivery of health care as well as for
education and prevention programs, physicians employed
by such institutions shall be reimbursed through a
salary included as part of such a budget.
(B) Salary ranges.--Salary ranges for health care
providers shall be determined in the same way as fee
schedules under paragraph (2).
(4) Salaries within capitated groups.--
(A) In general.--Health maintenance organizations,
group practices, and other institutions may elect to be
paid capitation premiums to cover all outpatient,
physician, and medical home care provided to
individuals enrolled to receive benefits through the
organization or entity.
(B) Scope.--Such capitation may include the costs
of services of licensed physicians and other licensed,
independent practitioners provided to inpatients. Other
costs of inpatient and institutional care shall be
excluded from capitation payments, and shall be covered
under institutions' global budgets.
(C) Prohibition of selective enrollment.--Selective
enrollment policies are prohibited, and patients shall
be permitted to enroll or disenroll from such
organizations or entities with appropriate notice.
(D) Health maintenance organizations.--Under this
Act--
(i) health maintenance organizations shall
be required to reimburse physicians based on a
salary; and
(ii) financial incentives between such
organizations and physicians based on
utilization are prohibited.
SEC. 203. PAYMENT FOR LONG-TERM CARE.
(a) Allotment for Regions.--The Program shall provide for each
region a single budgetary allotment to cover a full array of long-term
care services under this Act.
(b) Regional Budgets.--Each region shall provide a global budget to
local long-term care providers for the full range of needed services,
including in-home, nursing home, and community based care.
(c) Basis for Budgets.--Budgets for long-term care services under
this section shall be based on past expenditures, financial and
clinical performance, utilization, and projected changes in service,
wages, and other related factors.
(d) Favoring Non-Institutional Care.--All efforts shall be made
under this Act to provide long-term care in a home- or community-based
setting, as opposed to institutional care.
SEC. 204. MENTAL HEALTH SERVICES.
(a) In General.--The Program shall provide coverage for all
medically necessary mental health care on the same basis as the
coverage for other conditions. Licensed mental health clinicians shall
be paid in the same manner as specified for other health professionals,
as provided for in section 202(b).
(b) Favoring Community-Based Care.--The USNHI Program shall cover
supportive residences, occupational therapy, and ongoing mental health
and counseling services outside the hospital for patients with serious
mental illness. In all cases the highest quality and most effective
care shall be delivered, and, for some individuals, this may mean
institutional care.
SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, MEDICAL SUPPLIES, AND
MEDICALLY NECESSARY ASSISTIVE EQUIPMENT.
(a) Negotiated Prices.--The prices to be paid each year under this
Act for covered pharmaceuticals, medical supplies, and medically
necessary assistive equipment shall be negotiated annually by the
Program.
(b) Prescription Drug Formulary.--
(1) In general.--The Program shall establish a prescription
drug formulary system, which shall encourage best-practices in
prescribing and discourage the use of ineffective, dangerous,
or excessively costly medications when better alternatives are
available.
(2) Promotion of use of generics.--The formulary shall
promote the use of generic medications but allow the use of
brand-name and off-formulary medications when indicated for a
specific patient or condition.
(3) Formulary updates and petition rights.--The formulary
shall be updated frequently and clinicians and patients may
petition their region or the Director to add new
pharmaceuticals or to remove ineffective or dangerous
medications from the formulary.
SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSEMENT LEVELS.
Reimbursement levels under this subtitle shall be set after close
consultation with regional and State Directors and after the annual
meeting of National Board of Universal Quality and Access.
Subtitle B--Funding
SEC. 211. OVERVIEW: FUNDING THE USNHI PROGRAM.
(a) In General.--The USNHI Program is to be funded as provided in
subsections (b) and (c).
(b) Annual Appropriation for Funding of USNHI Program.--There are
authorized to be appropriated to carry out this Act such sums as may be
necessary.
(c) Intent.--Sums appropriated pursuant to subsection (b) shall be
paid for--
(1) by vastly reducing paperwork;
(2) by requiring a rational bulk procurement of
medications;
(3) from existing sources of Federal government revenues
for health care;
(4) by increasing personal income taxes on the top 5
percent income earners;
(5) by instituting a modest payroll tax; and
(6) by instituting a small tax on stock and bond
transactions.
SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS FOR UNINSURED AND
INDIGENT.
Notwithstanding any other provision of law, there are hereby
transferred and appropriated to carry out this Act, amounts equivalent
to the amounts the Secretary estimates would have been appropriated and
expended for Federal public health care programs for the uninsured and
indigent, including funds appropriated under the Medicare program under
title XVIII of the Social Security Act, under the Medicaid program
under title XIX of such Act, and under the Children's Health Insurance
Program under title XXI of such Act.
TITLE III--ADMINISTRATION
SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DIRECTOR.
(a) In General.--Except as otherwise specifically provided, this
Act shall be administered by the Secretary through a Director appointed
by the Secretary.
(b) Long-Term Care.--The Director shall appoint a director for
long-term care who shall be responsible for administration of this Act
and ensuring the availability and accessibility of high quality long-
term care services.
(c) Mental Health.--The Director shall appoint a director for
mental health who shall be responsible for administration of this Act
and ensuring the availability and accessibility of high quality mental
health services.
SEC. 302. OFFICE OF QUALITY CONTROL.
The Director shall appoint a director for an Office of Quality
Control. Such director shall, after consultation with state and
regional directors, provide annual recommendations to Congress, the
President, the Secretary, and other Program officials on how to ensure
the highest quality health care service delivery. The director of the
Office of Quality Control shall conduct an annual review on the
adequacy of medically necessary services, and shall make
recommendations of any proposed changes to the Congress, the President,
the Secretary, and other USNHI program officials.
SEC. 303. REGIONAL AND STATE ADMINISTRATION; EMPLOYMENT OF DISPLACED
CLERICAL WORKERS.
(a) Use of Regional Offices.--The Program shall establish and
maintain regional offices. Such regional offices shall replace all
regional Medicare offices.
(b) Appointment of Regional and State Directors.--In each such
regional office there shall be--
(1) one regional director appointed by the Director; and
(2) for each State in the region, a deputy director (in
this Act referred to as a ``State Director'') appointed by the
governor of that State.
(c) Regional Office Duties.--
(1) In general.--Regional offices of the Program shall be
responsible for--
(A) coordinating funding to health care providers
and physicians; and
(B) coordinating billing and reimbursements with
physicians and health care providers through a State-
based reimbursement system.
(d) State Director's Duties.--Each State Director shall be
responsible for the following duties:
(1) Providing an annual state health care needs assessment
report to the National Board of Universal Quality and Access,
and the regional board, after a thorough examination of health
needs, in consultation with public health officials,
clinicians, patients and patient advocates.
(2) Health planning, including oversight of the placement
of new hospitals, clinics, and other health care delivery
facilities.
(3) Health planning, including oversight of the purchase
and placement of new health equipment to ensure timely access
to care and to avoid duplication.
(4) Submitting global budgets to the regional director.
(5) Recommending changes in provider reimbursement or
payment for delivery of health services in the State.
(6) Establishing a quality assurance mechanism in the State
in order to minimize both under utilization and over
utilization and to assure that all providers meet high quality
standards.
(7) Reviewing program disbursements on a quarterly basis
and recommending needed adjustments in fee schedules needed to
achieve budgetary targets and assure adequate access to needed
care.
(e) First Priority in Retraining and Job Placement.--The Program
shall provide that clerical and administrative workers in insurance
companies, doctors offices, hospitals, nursing facilities and other
facilities whose jobs are eliminated due to reduced administration,
should have first priority in retraining and job placement in the new
system.
SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD SYSTEM.
(a) In General.--The Secretary shall create a standardized,
confidential electronic patient record system in accordance with laws
and regulations to maintain accurate patient records and to simplify
the billing process, thereby reducing medical errors and bureaucracy.
(b) Patient Option.--Notwithstanding that all billing shall be
preformed electronically, patients shall have the option of keeping any
portion of their medical records separate from their electronic medical
record.
SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND ACCESS.
(a) Establishment.--
(1) In general.--There is established a National Board of
Universal Quality and Access (in this section referred to as
the ``Board'') consisting of 15 members appointed by the
President, by and with the advice and consent of the Senate.
(2) Qualifications.--The appointed members of the Board
shall include at least one of each of the following:
(A) Health care professionals.
(B) Representatives of institutional providers of
health care.
(C) Representatives of health care advocacy groups.
(D) Representatives of labor unions.
(E) Citizen patient advocates.
(3) Terms.--Each member shall be appointed for a term of 6
years, except that the President shall stagger the terms of
members initially appointed so that the term of no more than 3
members expires in any year.
(4) Prohibition on conflicts of interest.--No member of the
Board shall have a financial conflict of interest with the
duties before the Board.
(b) Duties.--
(1) In general.--The Board shall meet at least twice per
year and shall advise the Secretary and the Director on a
regular basis to ensure quality, access, and affordability.
(2) Specific issues.--The Board shall specifically address
the following issues:
(A) Access to care.
(B) Quality improvement.
(C) Efficiency of administration.
(D) Adequacy of budget and funding.
(E) Appropriateness of reimbursement levels of
physicians and other providers.
(F) Capital expenditure needs.
(G) Long-term care.
(H) Mental health and substance abuse services.
(I) Staffing levels and working conditions in
health care delivery facilities.
(3) Establishment of universal, best quality standard of
care.--The Board shall specifically establish a universal, best
quality of standard of care with respect to--
(A) appropriate staffing levels;
(B) appropriate medical technology;
(C) design and scope of work in the health
workplace; and
(D) best practices.
(4) Twice-a-year report.--The Board shall report its
recommendations twice each year to the Secretary, the Director,
Congress, and the President.
(c) Compensation, Etc.--The following provisions of section 1805 of
the Social Security Act shall apply to the Board in the same manner as
they apply to the Medicare Payment Assessment Commission (except that
any reference to the Commission or the Comptroller General shall be
treated as references to the Board and the Secretary, respectively):
(1) Subsection (c)(4) (relating to compensation of Board
members).
(2) Subsection (c)(5) (relating to chairman and vice
chairman)
(3) Subsection (c)(6) (relating to meetings).
(4) Subsection (d) (relating to director and staff; experts
and consultants).
(5) Subsection (e) (relating to powers).
TITLE IV--ADDITIONAL PROVISIONS
SEC. 401. TREATMENT OF VA AND IHS HEALTH PROGRAMS.
This Act provides for health programs of the Department of
Veterans' Affairs and of the Indian Health Service to initially remain
independent for the 5-year period that begins on the date of the
establishment of the USNHI program, but after such period those
programs shall be integrated into the USNHI program.
SEC. 402. PUBLIC HEALTH AND PREVENTION.
It is the intent of this Act that the Program at all times stress
the importance of good public health through the prevention of
diseases.
SEC. 403. REDUCTION IN HEALTH DISPARITIES.
It is the intent of this Act to reduce health disparities by race,
ethnicity, income and geographic region, and to provide high quality,
cost-effective, culturally appropriate care to all individuals
regardless of race, ethnicity, sexual orientation, or language.
TITLE V--EFFECTIVE DATE
SEC. 501. EFFECTIVE DATE.
Except as otherwise specifically provided, this Act shall take
effect on January 1, 2005, and shall apply to items and services
furnished on or after such date.
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