[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 676 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 676

 To provide for comprehensive health insurance coverage for all United 
    States residents, improved health care delivery, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 11, 2011

  Mr. Conyers (for himself, Ms. Baldwin, Mr. Ellison, Mr. Filner, Mr. 
Hinchey, Mr. Jackson of Illinois, Ms. Lee of California, Ms. Pingree of 
Maine, Mr. Tonko, Mr. Frank of Massachusetts, Mr. Farr, Mr. Meeks, Mrs. 
 Maloney, Mr. Dicks, Ms. Chu, Mr. Grijalva, Mr. Doyle, Mr. Al Green of 
  Texas, Mr. Scott of Virginia, Mrs. Christensen, Ms. Zoe Lofgren of 
California, Ms. Roybal-Allard, Mr. Cohen, Mr. Capuano, Mr. Weiner, and 
 Mr. Nadler) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
 Ways and Means and Natural Resources, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To provide for comprehensive health insurance coverage for all United 
    States residents, improved health care delivery, and for other 
                               purposes.

    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 ``Expanded & 
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 Medicare For All Program.
Sec. 212. Appropriations for existing programs.
                       TITLE III--ADMINISTRATION

Sec. 301. Public administration; appointment of Director.
Sec. 302. Office of Quality Control.
Sec. 303. Regional and State administration; employment of displaced 
                            clerical workers.
Sec. 304. Confidential Electronic Patient Record System.
Sec. 305. National Board of Universal Quality and Access.
                    TITLE IV--ADDITIONAL PROVISIONS

Sec. 401. Treatment of VA and IHS health programs.
Sec. 402. Public health and prevention.
Sec. 403. Reduction in health disparities.
                        TITLE V--EFFECTIVE DATE

Sec. 501. Effective date.

SEC. 2. DEFINITIONS AND TERMS.

    In this Act:
            (1) Medicare for all program; program.--The terms 
        ``Medicare For All 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 
Medicare For All 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 
Medicare For All Program Card in the mail, after filling out a Medicare 
For All Program 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 Medicare For All Program Card and have 
payment made for such benefits.
    (d) Residency Criteria.--The Secretary shall promulgate a rule that 
provides criteria for determining residency for eligibility purposes 
under the Medicare For All Program.
    (e) Coverage for Visitors.--The Secretary shall promulgate a rule 
regarding visitors from other countries who seek premeditated non-
emergency surgical procedures. Such a rule should facilitate the 
establishment of country-to-country reimbursement arrangements or self 
pay arrangements between the visitor and the provider of care.

SEC. 102. BENEFITS AND PORTABILITY.

    (a) In General.--The health care benefits under this Act cover all 
medically necessary services, including at least the following:
            (1) Primary care and prevention.
            (2) Approved dietary and nutritional therapies.
            (3) Inpatient care.
            (4) Outpatient care.
            (5) Emergency care.
            (6) Prescription drugs.
            (7) Durable medical equipment.
            (8) Long-term care.
            (9) Palliative care.
            (10) Mental health services.
            (11) The full scope of dental services, services, including 
        periodontics, oral surgery, and endodontics, but not including 
        cosmetic dentistry.
            (12) Substance abuse treatment services.
            (13) Chiropractic services, not including electrical 
        stimulation.
            (14) Basic vision care and vision correction (other than 
        laser vision correction for cosmetic purposes).
            (15) Hearing services, including coverage of hearing aids.
            (16) Podiatric care.
    (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. 
        Private physicians, private clinics, and private health care 
        providers shall continue to operate as private entities, but 
        are prohibited from being investor owned.
            (2) Conversion of investor-owned providers.--For-profit 
        providers of care opting to participate shall be required to 
        convert to not-for-profit status.
            (3) Private delivery of care requirement.--For-profit 
        providers of care that convert to non-profit status shall 
        remain privately owned and operated entities.
            (4) Compensation for conversion.--The owners of such for-
        profit providers shall be compensated for reasonable financial 
        losses incurred as a result of the conversion from for-profit 
        to non-profit status.
            (5) 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).
            (6) Requirements.--The payments to owners of converting 
        for-profit providers shall occur during a 15-year period, 
        through the sale of U.S. Treasury Bonds. Payment for 
        conversions under paragraph (3) shall not be made for loss of 
        business profits.
            (7) Mechanism for conversion process.--The Secretary shall 
        promulgate a rule to provide a mechanism to further the timely, 
        efficient, and feasible conversion of for-profit providers of 
        care.
    (b) Quality Standards.--
            (1) In general.--Health care delivery facilities must meet 
        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 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 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, including amounts for 
                optimal physician, nurse, and other health care 
                professional staffing;
                    (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 Medicare For All 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, health professional education, 
        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 Medicare For All Program, through its 
        regional offices, shall pay each institutional provider of 
        care, including hospitals, nursing homes, community or migrant 
        health centers, home care agencies, or other institutional 
        providers or pre-paid group practices, 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, 
        State directors, 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, a provider's 
        maximum capacity to provide care, 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, pharmacists, 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 that is fair and optimal with 
                representatives of physicians and other clinicians, 
                after close consultation with the National Board of 
                Universal Quality and Access and regional and State 
                directors. Initially, the current prevailing fees or 
                reimbursement would be the basis for the fee 
                negotiation for all professional services covered under 
                this Act.
                    (B) Considerations.--In establishing such schedule, 
                the Director shall take into consideration the 
                following:
                            (i) The need for a uniform national 
                        standard.
                            (ii) The goal of ensuring that physicians, 
                        clinicians, pharmacists, and other medical 
                        professionals be compensated at a rate which 
                        reflects their expertise and the value of their 
                        services, regardless of geographic region and 
                        past fee schedules.
                    (C) State physician practice review boards.--The 
                State director for each State, in consultation with 
                representatives of the physician community of that 
                State, shall establish and appoint a physician practice 
                review board to assure quality, cost effectiveness, and 
                fair reimbursements for physician delivered services.
                    (D) Final guidelines.--The Director shall be 
                responsible for promulgating final guidelines to all 
                providers.
                    (E) Billing.--Under this Act physicians shall 
                submit bills to the regional director on a simple form, 
                or via computer. Interest shall be paid to providers 
                who are not reimbursed within 30 days of submission.
                    (F) No balance billing.--Licensed health care 
                clinicians who accept any payment from the Medicare For 
                All Program may not bill any patient for any covered 
                service.
                    (G) Uniform computer electronic billing system.--
                The Director shall create a uniform computerized 
                electronic billing system, including 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 and other 
                clinicians 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 payments 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.--Patients 
                shall be permitted to enroll or disenroll from such 
                organizations or entities without discrimination and 
                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 Medicare For All 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.
            (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 MEDICARE FOR ALL PROGRAM.

    (a) In General.--The Medicare For All Program is to be funded as 
provided in subsection (c)(1).
    (b) Medicare For All Trust Fund.--There shall be established a 
Medicare For All Trust Fund in which funds provided under this section 
are deposited and from which expenditures under this Act are made.
    (c) Funding.--
            (1) In general.--There are appropriated to the Medicare For 
        All Trust Fund amounts sufficient to carry out this Act from 
        the following sources:
                    (A) Existing sources of Federal Government revenues 
                for health care.
                    (B) Increasing personal income taxes on the top 5 
                percent income earners.
                    (C) Instituting a modest and progressive excise tax 
                on payroll and self-employment income.
                    (D) Instituting a modest tax on unearned income.
                    (E) Instituting a small tax on stock and bond 
                transactions.
            (2) System savings as a source of financing.--Funding 
        otherwise required for the Program is reduced as a result of--
                    (A) vastly reducing paperwork;
                    (B) requiring a rational bulk procurement of 
                medications under section 205(a); and
                    (C) improved access to preventive health care.
            (3) Additional annual appropriations to medicare for all 
        program.--Additional sums are authorized to be appropriated 
        annually as needed to maintain maximum quality, efficiency, and 
        access under the Program.

SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS.

    Notwithstanding any other provision of law, there are hereby 
transferred and appropriated to carry out this Act, amounts from the 
Treasury equivalent to the amounts the Secretary estimates would have 
been appropriated and expended for Federal public health care programs, 
including funds that would have been 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 Medicare For All Program officials.

SEC. 303. REGIONAL AND STATE ADMINISTRATION; EMPLOYMENT OF DISPLACED 
              CLERICAL WORKERS.

    (a) Establishment of Medicare For All Program Regional Offices.--
The Secretary shall establish and maintain Medicare For All regional 
offices for the purpose of distributing funds to providers of care. 
Whenever possible, the Secretary should incorporate pre-existing 
Medicare infrastructure for this purpose.
    (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.--Regional offices of the Program shall 
be responsible for--
            (1) coordinating funding to health care providers and 
        physicians; and
            (2) 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; 2 Years of 
Salary Parity Benefits.--The Program shall provide that clerical, 
administrative, and billing personnel in insurance companies, doctors 
offices, hospitals, nursing facilities, and other facilities whose jobs 
are eliminated due to reduced administration--
            (1) should have first priority in retraining and job 
        placement in the new system; and
            (2) shall be eligible to receive two years of Medicare For 
        All employment transition benefits with each year's benefit 
        equal to salary earned during the last 12 months of employment, 
        but shall not exceed $100,000 per year.
    (f) Establishment of Medicare For All Employment Transition Fund.--
The Secretary shall establish a trust fund from which expenditures 
shall be made to recipients of the benefits allocated in subsection 
(e).
    (g) Annual Appropriations to Medicare For All Employment Transition 
Fund.--Sums are authorized to be appropriated annually as needed to 
fund the Medicare For All Employment Transition Benefits.
    (h) Retention of Right to Unemployment Benefits.--Nothing in this 
section shall be interpreted as a waiver of Medicare For All Employment 
Transition benefit recipients' right to receive Federal and State 
unemployment benefits.

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;
                    (D) best practices; and
                    (E) salary level and working conditions of 
                physicians, clinicians, nurses, other medical 
                professionals, and appropriate support staff.
            (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.

    (a) VA Health Programs.--This Act provides for health programs of 
the Department of Veterans' Affairs to initially remain independent for 
the 10-year period that begins on the date of the establishment of the 
Medicare For All Program. After such 10-year period, the Congress shall 
reevaluate whether such programs shall remain independent or be 
integrated into the Medicare For All Program.
    (b) Indian Health Service Programs.--This Act provides for health 
programs of the Indian Health Service to initially remain independent 
for the 5-year period that begins on the date of the establishment of 
the Medicare For All Program, after which such programs shall be 
integrated into the Medicare For All 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 the first day of the first year that begins more than 1 year 
after the date of the enactment of this Act, and shall apply to items 
and services furnished on or after such date.
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