[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 581 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                 S. 581

To establish a Citizens Health Care Working Group to facilitate public 
debate about how to improve the health care system for Americans and to 
provide for a vote by Congress on the recommendations that are derived 
                           from this debate.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 10, 2003

 Mr. Wyden (for himself and Mr. Hatch) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To establish a Citizens Health Care Working Group to facilitate public 
debate about how to improve the health care system for Americans and to 
provide for a vote by Congress on the recommendations that are derived 
                           from this debate.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Care That Works for All 
Americans Act of 2003''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) In order to improve the health care system, the 
        American public must engage in an informed national public 
        debate to make choices about the services they want covered, 
        what health care coverage they want, and how they are willing 
        to pay for coverage.
            (2) More than a trillion dollars annually is spent on the 
        health care system, yet--
                    (A) 41,000,000 Americans are uninsured;
                    (B) insured individuals do not always have access 
                to essential, effective services to improve and 
                maintain their health; and
                    (C) employers, who cover over 170,000,000 
                Americans, find providing coverage increasingly 
                difficult because of rising costs and double digit 
                premium increases.
            (3) Despite increases in medical care spending that are 
        greater than the rate of inflation, population growth, and 
        Gross Domestic Product growth, there has not been a 
        commensurate improvement in our health status as a nation.
            (4) Health care costs for even just 1 member of a family 
        can be catastrophic, resulting in medical bills potentially 
        harming the economic stability of the entire family.
            (5) Common life occurrences can jeopardize the ability of a 
        family to retain private coverage or jeopardize access to 
        public coverage.
            (6) Innovations in health care access, coverage, and 
        quality of care, including the use of technology, have often 
        come from States, local communities, and private sector 
        organizations, but more creative policies could tap this 
        potential.
            (7) Despite our Nation's wealth, the health care system 
        does not provide coverage to all Americans who want it.

SEC. 3. PURPOSES.

    The purposes of this Act are--
            (1) to provide for a nationwide public debate about 
        improving the health care system to provide every American with 
        the ability to obtain quality, affordable health care coverage; 
        and
            (2) to provide for a vote by Congress on the 
        recommendations that result from the debate.

SEC. 4. CITIZENS' HEALTH CARE WORKING GROUP.

    (a) Establishment.--The Secretary, acting through the Agency for 
Healthcare Research and Quality, shall establish an entity to be known 
as the Citizens' Health Care Working Group (referred to in this Act as 
the ``Working Group'').
    (b) Appointment.--Not later than 45 days after the date of 
enactment of this Act, the Speaker and Minority Leader of the House of 
Representatives and the Majority Leader and Minority Leader of the 
Senate (in this section referred to as the ``leadership'') shall each 
appoint individuals to serve as members of the Working Group in 
accordance with subsections (c), (d), and (e).
    (c) Membership Criteria.--
            (1) Appointed members.--
                    (A) Separate appointments.--The Speaker of the 
                House of Representatives jointly with the Minority 
                Leader of the House of Representatives, and the 
                Majority Leader of the Senate jointly with the Minority 
                Leader of the Senate, shall each appoint 1 member of 
                the Working Group described in subparagraphs (A), (G), 
                (J), (K), and (M) of paragraph (2).
                    (B) Joint appointments.--Members of the Working 
                Group described in subparagraphs (B), (C), (D), (E), 
                (F), (I), and (N) of paragraph (2) shall be appointed 
                jointly by the leadership.
                    (C) Combined appointments.--Members of the Working 
                Group described in subparagraphs (H) and (L) shall be 
                appointed in the following manner:
                            (i) One member of the Working Group in each 
                        of such subparagraphs shall be appointed 
                        jointly by the leadership.
                            (ii) The remaining appointments of the 
                        members in each of such subparagraphs shall be 
                        divided equally such that the Speaker of the 
                        House of Representatives jointly with the 
                        Minority Leader of the House of 
                        Representatives, and the Majority Leader of the 
                        Senate jointly with the Minority Leader of the 
                        Senate each appoint an equal number of members.
            (2) Categories of appointed members.--Members of the 
        Working Group shall be appointed as follows:
                    (A) 2 members shall be patients or family members 
                of patients who, at least 1 year prior to the date of 
                enactment of this Act, have had no health insurance.
                    (B) 1 member shall be a representative of children.
                    (C) 1 member shall be a representative of the 
                mentally ill.
                    (D) 1 member shall be a representative of the 
                disabled.
                    (E) 1 member shall be over the age of 65 and a 
                beneficiary under the medicare program established 
                under title XVIII of the Social Security Act (42 U.S.C. 
                1395 et seq.).
                    (F) 1 member shall be a recipient of benefits under 
                the medicaid program under title XIX of the Social 
                Security Act (42 U.S.C. 1396 et seq.).
                    (G) 2 members shall be State health officials.
                    (H) 3 members shall be employers, including--
                            (i) 1 large employer (an employer who 
                        employed 50 or more employees on business days 
                        during the preceding calendar year and who 
                        employed at least 50 employees on the first of 
                        the year);
                            (ii) 1 small employer (an employer who 
                        employed an average of at least 2 employees but 
                        less than 50 employees on business days in the 
                        preceding calendar year and who employs at 
                        least 2 employees on the first of the year); 
                        and
                            (iii) 1 multi-state employer.
                    (I) 1 member shall be a representative of labor.
                    (J) 2 members shall be health insurance issuers.
                    (K) 2 members shall be health care providers.
                    (L) 5 members shall be appointed as follows:
                            (i) 1 economist.
                            (ii) 1 academician.
                            (iii) 1 health policy researcher.
                            (iv) 1 individual with expertise in 
                        pharmacoeconomics.
                            (v) 1 health technology expert.
                    (M) 2 members shall be representatives of community 
                leaders who have developed State or local community 
                solutions to the problems addressed by the Working 
                Group.
                    (N) 1 member shall be a representative of a medical 
                school.
            (3) Secretary.--The Secretary of Health and Human Services 
        or the designee of the Secretary of Health and Human Services 
        shall be a member of the Working Group.
    (d) Prohibited Appointments.--Members of the Working Group shall 
not include members of Congress or other elected government officials 
(Federal, State, or local) other than those individuals specified in 
subsection (c). To the extent possible, individuals appointed to the 
Working Group shall have used the health care system within the 
previous 2 years and shall not be paid employees or representatives of 
associations or advocacy organizations involved in the health care 
system.
    (e) Appointment Criteria.--
            (1) House of representatives.--The Speaker and Minority 
        Leader of the House of Representatives shall make the 
        appointments described in subsection (b) in consultation with 
        the chairperson and ranking member of the following committees 
        of the House of Representatives:
                    (A) The Committee on Ways and Means.
                    (B) The Committee on Energy and Commerce.
                    (C) The Committee on Education and the Workforce.
            (2) Senate.--The Majority Leader and Minority Leader of the 
        Senate shall make the appointments described in subsection (b) 
        in consultation with the chairperson and ranking member of the 
        following committees of the Senate:
                    (A) The Committee on Finance.
                    (B) The Committee on Health, Education, Labor, and 
                Pensions.
    (f) Period of Appointment.--Members of the Working Group shall be 
appointed for a term of 2 years. Such term is renewable and any 
vacancies shall not affect the power and duties of the Working Group 
but shall be filled in the same manner as the original appointment.
    (g) Appointment of the Chairperson.--Not later than 15 days after 
the date on which all members of the Working Group have been appointed 
under subsection (b), the leadership shall make a joint designation of 
the chairperson of the Working Group. If the leadership fails to make 
such designation within such time period, the Working Group Members 
shall, not later than 10 days after the end of such time period, 
designate a chairperson by majority vote.
    (h) Subcommittees.--The Working Group may establish subcommittees 
if doing so increases the efficiency of the Working Group in completing 
its tasks.
    (i) Duties.--
            (1) Hearings.--Not later than 90 days after the date of 
        appointment of the chairperson under subsection (g), the 
        Working Group shall hold hearings to examine--
                    (A) the capacity of the public and private health 
                care systems to expand coverage options;
                    (B) the cost of health care and the effectiveness 
                of care provided at all stages of disease, but in 
                particular the cost of services at the end of life;
                    (C) innovative State strategies used to expand 
                health care coverage and lower health care costs;
                    (D) local community solutions to accessing health 
                care coverage;
                    (E) efforts to enroll individuals currently 
                eligible for public or private health care coverage;
                    (F) the role of evidence-based medical practices 
                that can be documented as restoring, maintaining, or 
                improving a patient's health, and the use of technology 
                in supporting providers in improving quality of care 
                and lowering costs; and
                    (G) strategies to assist purchasers of health care, 
                including consumers, to become more aware of the impact 
of costs, and to lower the costs of health care.
            (2) Additional hearings.--The Working Group may hold 
        additional hearings on subjects other than those listed in 
        paragraph (1) so long as such hearings are determined to be 
        necessary by the Working Group in carrying out the purposes of 
        this Act. Such additional hearings do not have to be completed 
        within the time period specified in paragraph (1) but shall not 
        delay the other activities of the Working Group under this 
        section.
            (3) The health report to the american people.--Not later 
        than 90 days after the hearings described in paragraphs (1) and 
        (2) are completed, the Working Group shall prepare and make 
        available to health care consumers through the Internet and 
        other appropriate public channels, a report to be entitled, 
        ``The Health Report to the American People''. Such report shall 
        be understandable to the general public and include--
                    (A) a summary of--
                            (i) health care and related services that 
                        may be used by individuals throughout their 
                        life span;
                            (ii) the cost of health care services and 
                        their medical effectiveness in providing better 
                        quality of care for different age groups;
                            (iii) the source of coverage and payment, 
                        including reimbursement, for health care 
                        services;
                            (iv) the reasons people are uninsured or 
                        underinsured and the cost to taxpayers, 
                        purchasers of health services, and communities 
                        when Americans are uninsured or underinsured;
                            (v) the impact on health care outcomes and 
                        costs when individuals are treated in later 
                        stages of disease;
                            (vi) health care cost containment 
                        strategies; and
                            (vii) information on health care needs that 
                        need to be addressed;
                    (B) examples of community strategies to provide 
                health care coverage or access;
                    (C) information on geographic-specific issues 
                relating to health care;
                    (D) information concerning the cost of care in 
                different settings, including institutional-based care 
                and home and community-based care;
                    (E) a summary of ways to finance health care 
                coverage; and
                    (F) the role of technology in providing future 
                health care including ways to support the information 
                needs of patients and providers.
            (4) Community meetings.--
                    (A) In general.--Not later than 1 year after the 
                date of enactment of this Act, the Working Group shall 
                initiate health care community meetings throughout the 
                United States (in this section referred to as 
                ``community meetings''). Such community meetings may be 
                geographically or regionally based and shall be 
                completed within 180 days after the initiation of the 
                first meeting.
                    (B) Number of meetings.--The Working Group shall 
                hold a sufficient number of community meetings in order 
                to receive information that reflects--
                            (i) the geographic differences throughout 
                        the United States;
                            (ii) diverse populations; and
                            (iii) a balance among urban and rural 
                        populations.
                    (C) Meeting requirements.--
                            (i) Facilitator.--A State health officer 
                        may be the facilitator at the community 
                        meetings.
                            (ii) Attendance.--At least 1 member of the 
                        Working Group shall attend and serve as chair 
                        of each community meeting. Other members may 
                        participate through interactive technology.
                            (iii) Topics.--The community meetings 
                        shall, at a minimum, address the following 
                        issues:
                                    (I) The optimum way to balance 
                                costs and benefits so that affordable 
                                health coverage is available to as many 
                                people as possible.
                                    (II) The identification of services 
                                that provide cost-effective, essential 
                                health care services to maintain and 
                                improve health and which should be 
                                included in health care coverage.
                                    (III) The cost of providing 
                                increased benefits.
                                    (IV) The mechanisms to finance 
                                health care coverage, including 
                                defining the appropriate financial role 
                                for individuals, businesses, and 
                                government.
                            (iv) Interactive technology.--The Working 
                        Group may encourage public participation in 
                        community meetings through interactive 
                        technology and other means as determined 
                        appropriate by the Working Group.
                    (D) Interim requirements.--Not later than 180 days 
                after the date of completion of the community meetings, 
                the Working Group shall prepare and make available to 
                the public through the Internet and other appropriate 
                public channels, an interim set of recommendations on 
                health care coverage and ways to improve and strengthen 
                the health care system based on the information and 
                preferences expressed at the community meetings. There 
                shall be a 90-day public comment period on such 
                recommendations.
    (j) Recommendations.--Not later than 120 days after the expiration 
of the public comment period described in subsection (h)(3)(D), the 
Working Group shall submit to Congress and the President a final set of 
recommendations, including any proposed legislative language to 
implement such recommendations.
    (k) Administration.--
            (1) Executive director.--There shall be an Executive 
        Director of the Working Group who shall be appointed by the 
        chairperson of the Working Group in consultation with the 
        members of the Working Group.
            (2) Compensation.--While serving on the business of the 
        Working Group (including travel time), a member of the Working 
        Group shall be entitled to compensation at the per diem 
        equivalent of the rate provided for level IV of the Executive 
        Schedule under section 5315 of title 5, United States Code, and 
        while so serving away from home and the member's regular place 
        of business, a member may be allowed travel expenses, as 
        authorized by the chairperson of the Working Group. For 
        purposes of pay and employment benefits, rights, and 
        privileges, all personnel of the Working Group shall be treated 
        as if they were employees of the Senate.
            (3) Information from federal agencies.--The Working Group 
        may secure directly from any Federal department or agency such 
information as the Working Group considers necessary to carry out this 
Act. Upon request of the Working Group, the head of such department or 
agency shall furnish such information.
            (4) Postal services.--The Working Group may use the United 
        States mails in the same manner and under the same conditions 
        as other departments and agencies of the Federal Government.
    (l) Detail.--Not more than 10 Federal Government employees employed 
by the Department of Labor and 10 Federal Government employees employed 
by the Department of Health and Human Services may be detailed to the 
Working Group under this section without further reimbursement. Any 
detail of an employee shall be without interruption or loss of civil 
service status or privilege.
    (m) Temporary and Intermittent Services.--The chairperson of the 
Working Group may procure temporary and intermittent services under 
section 3109(b) of title 5, United States Code, at rates for 
individuals which do not exceed the daily equivalent of the annual rate 
of basic pay prescribed for level V of the Executive Schedule under 
section 5316 of such title.
    (n) Annual Report.--Not later that 1 year after the date of 
enactment of this Act, and annually thereafter during the existence of 
the Working Group, the Working Group shall report to Congress and make 
public a detailed description of the expenditures of the Working Group 
used to carry out its duties under this section.
    (o) Sunset of Working Group.--The Working Group shall terminate 
when the report described in subsection (j) is submitted to Congress.

SEC. 5. CONGRESSIONAL ACTION.

    (a) Drafting.--If the Working Group does not provide legislative 
language in the report under section 4(j) then the committees described 
in paragraphs (1) and (2) of section 4(e) may draft legislative 
language based on the recommendations of the Working Group.
    (b) Bill Introduction.--
            (1) In general.--Any legislative language described in 
        subsection (a) may be introduced as a bill by request in the 
        following manner:
                    (A) House of representatives.--In the House of 
                Representatives, by the Majority Leader and the 
                Minority Leader not later than 10 days after receipt of 
                the legislative language.
                    (B) Senate.--In the Senate, by the Majority Leader 
                and the Minority Leader not later than 10 days after 
                receipt of the legislative language.
            (2) Alternative by administration.--The President may 
        submit legislative language based on the recommendations of the 
        Working Group and such legislative language may be introduced 
        in the manner described in paragraph (1).
    (c) Committee Consideration.--
            (1) In general.--Any legislative language submitted 
        pursuant to paragraph (1) or (2) of subsection (b) (in this 
        section referred to as ``implementing legislation'') shall be 
        referred to the appropriate committees of the House of 
        Representatives and the Senate.
            (2) Reporting.--
                    (A) Committee action.--If, not later than 150 days 
                after the date on which the implementing legislation is 
                referred to a committee under paragraph (1), the 
                committee has reported the implementing legislation or 
                has reported an original bill whose subject is related 
                to reforming the health care system, or to providing 
                access to affordable health care coverage for 
                Americans, the regular rules of the applicable House of 
                Congress shall apply to such legislation.
                    (B) Discharge from committees.--
                            (i) Senate.--
                                    (I) In general.--If the 
                                implementing legislation or an original 
                                bill described in subparagraph (A) has 
                                not been reported by a committee of the 
                                Senate within 180 days after the date 
                                on which such legislation was referred 
                                to committee under paragraph (1), it 
                                shall be in order for any Senator to 
                                move to discharge the committee from 
                                further consideration of such 
                                implementing legislation.
                                    (II) Sequential referrals.--Should 
                                a sequential referral of the 
                                implementing legislation be made, the 
                                additional committee has 30 days for 
                                consideration of implementing 
                                legislation before the discharge motion 
                                described in subclause (I) would be in 
                                order.
                                    (III) Procedure.--The motion 
                                described in subclause (I) shall not be 
                                in order after the implementing 
                                legislation has been placed on the 
                                calendar. While the motion described in 
                                subclause (I) is pending, no other 
                                motions related to the motion described 
                                in subclause (I) shall be in order. 
                                Debate on a motion to discharge shall 
                                be limited to not more than 10 hours, 
                                equally divided and controlled by the 
                                majority leader and the minority 
                                leader, or their designees. An 
                                amendment to the motion shall not be in 
                                order, nor shall it be in order to move 
                                to reconsider the vote by which the 
                                motion is agreed or disagreed to.
                                    (IV) Exception.--If implementing 
                                language is submitted on a date later 
                                than May 1 of the second session of a 
                                Congress, the committee shall have 90 
                                days to consider the implementing 
                                legislation before a motion to 
                                discharge under this clause would be in 
                                order.
                            (ii) House of representatives.--If the 
                        implementing legislation or an original bill 
                        described in subparagraph (A) has not been 
                        reported out of a committee of the House of 
                        Representatives within 180 days after the date 
                        on which such legislation was referred to 
                        committee under paragraph (1), then on any day 
                        on which the call of the calendar for motions 
                        to discharge committees is in order, any member 
                        of the House of Representatives may move that 
                        the committee be discharged from consideration 
                        of the implementing legislation, and this 
                        motion shall be considered under the same terms 
                        and conditions, and if adopted the House of 
                        Representatives shall follow the procedure 
                        described in subsection (d)(1).
    (d) Floor Consideration.--
            (1) Motion to proceed.--If a motion to discharge made 
        pursuant to subsection (c)(2)(B)(i) or (c)(2)(B)(ii) is 
        adopted, then, not earlier than 5 legislative days after the 
        date on which the motion to discharge is adopted, a motion may 
        be made to proceed to the bill.
            (2) Failure of motion.--If the motion to discharge made 
        pursuant to subsection (c)(2)(B)(i) or (c)(2)(B)(ii) fails, 
        such motion may be made not more than 2 additional times, but 
        in no case more frequently than within 30 days of the previous 
        motion. Debate on each of such motions shall be limited to 5 
        hours, equally divided.
            (3) Applicable rules.--Once the Senate is debating the 
        implementing legislation the regular rules of the Senate shall 
        apply.

SEC. 6. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated to carry 
out this Act, other than section 4(i)(3), $3,000,000 for each of fiscal 
years 2004, 2005, and 2006.
    (b) Health Report to the American People.--There are authorized to 
be appropriated for the preparation and dissemination of the Health 
Report to the American People described in section 4(i)(3), such sums 
as may be necessary for the fiscal year in which the report is required 
to be submitted.
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