II 110th CONGRESS 1st Session S. 1019 IN THE SENATE OF THE UNITED STATES March 28, 2007 Mr. Coburn (for himself, Mr. Burr, Mr. Chambliss, and Mr. Inhofe) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To provide comprehensive reform of the health care system of the United States, and for other purposes.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Universal Health Care Choice and Access Act. (b)

Table of contents

The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Findings. TITLE I—Prevention and Wellness Sec. 101. Strategic approach to outcome-based prevention. Sec. 102. State grants for outcome-based prevention effort. Sec. 103. Keeping the food stamp program focused on nutrition. Sec. 104. Immunizations. TITLE II—Tax incentives to encourage purchase of health care insurance Subtitle A—Health Savings Accounts Sec. 201. Expansion of health savings accounts. Sec. 202. Exception to requirement for employers to make comparable health savings account contributions. Subtitle B—MediChoice tax rebates Sec. 211. Refundable credit for health insurance coverage. Sec. 212. Advance payment of credit for purchasers of qualified health insurance. Sec. 213. Termination of employer-provided health care coverage exclusion. TITLE III—Health insurance modernization Subtitle A—Employee choice Sec. 301. Clarification of definition of group health plan under HIPAA. Subtitle B—Access to health care Sec. 311. State high risk pools. Sec. 312. Federally qualified health centers. Subtitle C—Interstate market for health insurance Sec. 321. Short title. Sec. 322. Specification of constitutional authority for enactment of law. Sec. 323. Findings. Sec. 324. Cooperative governing of individual health insurance coverage. Sec. 325. Severability. TITLE IV—Improvements to the Medicare program Subtitle A—MediChoice for Seniors Sec. 401. Setting the benchmark equal to the national average bid. Sec. 402. Enhancement of beneficiary rebates. Sec. 403. Alternative benefit design to original medicare fee-for-service benefits. Sec. 404. Medicare advantage HSA plans. Sec. 405. Review of adjustment mechanism used under the Medicare Advantage program. Subtitle B—Enhancements to the Medicare Fee-For-Service Program Sec. 411. Elimination of annual indexing of income thresholds for reduced part B premium subsidies. Sec. 412. Authority to adjust amount of Medicare part B premium to reward positive health behavior. Sec. 413. Recapture of Medicare DSH funds. Sec. 414. Price transparency requirements for Medicare providers. Subtitle C—Value-Based Purchasing Sec. 421. Repeal of physician ownership referral prohibitions based on compensation arrangements. Sec. 422. Revision of designated health services subject to ownership referral prohibition. Sec. 423. Exceptions to ownership referral prohibitions. Sec. 424. Effective date. Subtitle D—Securing Medicare's future for tomorrow's seniors Sec. 431. Medical Retirement Accounts. TITLE V—Keeping Medicaid on Mission Sec. 501. Restructuring of Medicaid funding. Sec. 502. Medicaid Advantage program. Sec. 503. High performance bonuses. TITLE VI—Administrative health care tribunals Sec. 601. State grants to create administrative health care tribunals. TITLE VII—Health information technology Subtitle A—Assisting the development of health information technology Sec. 701. Purpose. Sec. 702. Health record banking. Sec. 703. Application of Federal and State security and confidentiality standards. Subtitle B—Promoting the use of health information technology to better coordinate health care Sec. 711. Safe harbors to antikickback civil penalties and criminal penalties for provision of health information technology and training services. Sec. 712. Exception to limitation on certain physician referrals (under stark) for provision of health information technology and training services to health care professionals. Sec. 713. Rules of construction regarding use of consortia. TITLE VIII—Miscellaneous Sec. 801. Dedication of Medicaid and revenue savings to strengthening the financial solvency of the Federal Hospital Insurance Trust Fund. Sec. 802. Health care choice for veterans. Sec. 803. Health care choice for Indians.

2.

Findings

Congress makes the following findings: (1)Nine out of 10 Americans think the United States health care system needs fundamental changes. (2)The United States spends approximately 16 percent of its Gross Domestic Product on health care and experts estimate that percentage will rise to 20 percent by 2015. (3)The Federal Government spends more on health care than it does on national defense. (4)As much as $1 out of every $4 health care dollars do not go towards making Americans healthy. (5)Nearly 75 percent of American health care spending goes toward the treatment of chronic diseases. Five preventable chronic diseases (heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes) cause two-thirds of American deaths. (6)Since 2000, premiums for family health coverage have increased by 87 percent, compared with cumulative inflation of 18 percent and cumulative wage growth of 20 percent. During this same period, the percentage of employers offering health benefits has fallen from 69 percent to 61 percent, and the percentage of workers covered by their own employer also has fallen. The current employer-based system offers little choice in health plans to employees: 88 percent of American firms offer only 1 health plan type. (7)Medicaid was designed as a safety net to ensure that the poorest Americans have access to health care at a cost of $1,000,000,000 in its first year. Today, more than 1 out of every 6 Americans is in Medicaid at a total cost of more than $338,000,000,000 in 2006. The program is expected to cost nearly $5,000,000,000,000 over the next decade. In 2003, for the first time ever, Medicaid spending replaced education as the largest component of State budgets, consuming 22 percent of State spending. (8)The unfunded liabilities of the Medicare Program over the next 75 years are estimated to be $32,100,000,000,000 and $70,500,000,000,000 on the infinite horizon. The Federal Hospital Insurance Trust Fund is projected to be exhausted by 2018. Without any change in the program, Medicare will consume 23.1 percent of all Federal income taxes by 2020 and 37.5 percent of all Federal income taxes by 2030. Under the current system, physician reimbursements will be cut by 34 percent by the year 2015, leading to decreased access to physicians' services for seniors. (9)Our current civil justice system is adversely affecting patient access to health care services, better patient care, and cost-efficient health care, in that the health care liability system is a costly and ineffective mechanism for resolving claims of health care liability and compensating injured patients, and is a deterrent to the sharing of information among health care professionals which impedes efforts to improve patient safety and quality of care. Economists estimate that between 5 and 9 percent of health care spending is related to defensive medicine. (10)The adoption of health information technology will significantly reduce health care spending while simultaneously increasing the quality of health care.