[Congressional Record Volume 146, Number 94 (Wednesday, July 19, 2000)]
[Senate]
[Pages S7229-S7238]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WELLSTONE:
  S. 2888. A bill to guarantee for all Americans quality, affordable, 
and comprehensive health insurance coverage; to the Committee on 
Finance.


                 health security for all americans act

  Mr. WELLSTONE. Mr. President, today I want to talk about an issue 
that is of the utmost importance: Health Security.

  First I want to talk about the problem: Health insecurity. Then I 
want to talk about the solution: The Health Security for All Americans 
Act. And finally I want people around the country to hear what they can 
do to wake up Congress and make Health Security for All Americans a 
reality.
  This year has been a hard one for me. Two months ago, we buried one 
of my dear friends, Mike Epstein. Mike's sons came to be with him for 
the last few weeks of his struggle with cancer. Devoted sons, they 
spoke glowingly about their father at a memorial service for him in the 
Capitol. As any of you who has sat with a dying parent knows, emotions 
overflow, coping is difficult, and the grief is profound. The last 
thing a son or daughter, a parent or spouse, needs is to have the 
additional burden of wondering where will the next dollar for ever 
mounting health care bills come from; to worry about going into debt; 
to worry about going bankrupt because of a loved ones health care 
needs. Mike's sons did not have to worry about that because Mike had 
health care coverage as good as Congress gets.

[[Page S7230]]

  The wife of my health policy advisor, John Gilman, battled cancer for 
two and a half years before succumbing one month ago. She had required 
innumerable sessions of radiation therapy, plus chemotherapy and 
surgery. John had his hands full with work plus taking care of his 
wife, both physically and emotionally. It is draining, but can you 
imagine how much worse it would be if John and his wife, June, had no 
health insurance. John didn't have to worry about how to pay for the 
next medical bill because John and his wife had health care coverage as 
good as Congress gets.
  People do get ill. As hard as we try and as much as we pray, we can't 
always cure them. But we certainly can make sure they all have access 
to high quality, affordable care with dignity. There is no reason why 
all Americans can't have health insurance as good as everyone of us who 
serves in the United States Senate.
  The idea of procuring health security for all Americans is not a new 
one. Franklin Delano Roosevelt recognized the need for universal health 
care in the 1930s when we were in the depths of the depression; Harry 
Truman fought for it in the 1940s when the troops came home from World 
War II; John Kennedy envisioned it in the midst of the cold war; 
Richard Nixon had it high on his agenda before events overtook his 
Presidency.
  What these 20th century Presidents all understood is that there is a 
basic human drive for good health, and the good health of the American 
people is what drives this country and its economy. By 1992 it was far 
past due for us to recognize that all Americans should have a basic 
right to quality affordable health care. We had the opportunity in 1993 
and 1994 to confer that right on to all of our people--and we lost it, 
because of differences and failures to compromise, and obstructionists 
and nay sayers, and failing to keep our eye on the ball: Universal, 
quality, affordable health care for every American.
  I began introducing bills to provide universal health care in this 
country shortly after I arrived in the Senate in 1991. Back then people 
were aware of the problems of the uninsured--it wasn't being swept 
under the rug. Do you remember back in 1992, we were coming out of a 
recession, unemployment was at 7.5 percent, the national debt was 
increasing each year and 36 million Americans were uninsured, and 
everyone was talking about some form of health insurance for all.
  Eight years later, we're told the economy's humming along, 
unemployment is the lowest its been in 30 years, and there is a 
budgetary surplus. But despite the fact that there are 45 million 
Americans without health insurance--10 million more than there were 10 
years ago--nobody in Washington is talking seriously about doing 
anything about it. Incremental change may keep some people from losing 
their insurance, and may insure some people who would otherwise be 
uninsured, but incrementalism has not stopped the steady rise in the 
number of uninsured in America which will soar to 55 million people by 
2008.
  We need to change that. I don't think the fact that 140 million 
Americans own stocks today should make us forget that 45 million 
Americans don't have health insurance. And that millions more can't 
make ends meet because their health insurance is simply too expensive.
  Make no mistake about it: Not having health insurance has its 
consequences. And I know some of you know it personally too well. There 
are some myths out there about not having health insurance that need to 
be debunked:
  The first myth is that the uninsured can easily get the care they 
need. But the fact is: Uninsured Americans needlessly suffer because 
they don't have access to the care they need. For example, the 
uninsured are four times more likely to go without needed medical care 
and to delay seeking care; and are up to four times more likely to 
experience an avoidable hospitalization and emergency hospital care. 
The uninsured are more likely to be in fair or poor health and have a 
higher probability of in-hospital death than the privately insured.
  The second myth is that the lack of health insurance is usually a 
temporary condition and that most people get their coverage back 
quickly. But the fact is otherwise: Nearly 60 percent of people who are 
uninsured have been uninsured for at least two years. Or put another 
way: 6 out of 10 people who lose their health insurance this month will 
still be uninsured in July 2002!
  Employers used to do more to help assure their workers of coverage. 
In 1985, nearly two-thirds of businesses with 100 or more workers paid 
the full cost of health coverage. Last year only one-fourth of 
businesses did. In 1988, employers asked workers to pay on average 20 
percent of the cost through payroll deductions. By 1998, they had 
raised the average worker's share to 27 percent. Three-fourths of the 
working uninsured are not offered or eligible for any coverage through 
their workplace.
  The third myth is that most people don't have health insurance 
because they are not working. But the fact is: 75 percent of uninsured 
Americans hold down full-time jobs or are the dependents of someone who 
does, and nine out of ten come from working families. What's also a 
fact is that low wage workers frequently aren't offered insurance at 
all through their employment or if they are, it is at an unaffordable 
price.
  The fourth myth is that most people who don't have insurance could 
afford it but just choose not to buy it. But the fact is: The high cost 
of health insurance premiums is the main reason that half the uninsured 
don't have health insurance. Only 3 percent of people without insurance 
say the most important reason is because they don't think they need it.
  Going without health insurance means living in poorer health. Most 
uninsured adults have no regular source of health care. Most postpone 
getting care. Three in ten go without needed medical care. A quarter 
forego getting the medicine they need because they cannot afford to 
fill their medical prescriptions. Uninsured children are 30 percent 
more likely to fall behind on well-child care and 80 percent more 
likely to never have routine care at all.
  The uninsured are three to four times more likely to have problems 
getting the health care they feel the need. Uninsured children are at 
least 70 percent more likely not to get medical care for common 
conditions--like asthma--that if left untreated can lead to more 
serious health problems.
  Uninsured Americans are more likely to end up hospitalized for 
conditions--like uncontrolled diabetes--that they could have avoided 
with better health care. In the end, uninsured patients are more likely 
to die while hospitalized than privately insured patients with the same 
health problems.
  Partly because they are less likely to get regular mammograms, 
uninsured women are nearly 50 percent more likely to die of breast 
cancer. Our system takes its toll in senseless, random pain and 
suffering.
  Without insurance, the medical bills mount quickly. More than one in 
three uninsured adults have problems paying their medical bills. The 
uninsured are three times more likely to have problems with their 
medical bills than the insured. Eight out of ten uninsured people 
receive absolutely no reduced charge or free health services. The 
crushing weight of bankruptcy looms on the horizon. One out of four 
people filing for bankruptcy identified an illness or injury as a major 
reason for filing; 1 out of 3 had substantial medical bills; and almost 
50 percent had both.
  Even with insurance, low- and middle-income families frequently find 
themselves in a financial straight jacket. Families with annual incomes 
of $30,000 or less are spending an inordinate, unaffordable share of 
their income on health care expenses. And the average family with an 
income under $10,000 is paying well over 20 percent of its annual 
income on health care costs. These families can least afford to make 
that kind of payment.
  For families with annual incomes of $30,000 or more, the average 
amount of that income spent on premiums, deductibles and co-pays drops 
to below 5 percent on average. But these are just averages: many 
families at every income level spend more than 10 percent of their 
family income on health care, especially if someone in the family has a 
serious illness. That is not affordable. That is not fair.
  Since coming to the Senate, my number one priority has been achieving 
universal, affordable, comprehensive, quality care for all Americans. 
That is

[[Page S7231]]

why I am proud to be introducing today the Health Security for All 
Americans Act.
  Let me digress and tell you how I arrived at this legislation.
  When I was first elected to the Senate and Bill Clinton was elected 
president two years later, I believed the political winds and tides 
were aligned for a decade of progressive change for America. I thought 
I had been elected at just the right time to be a part of this change. 
When President Clinton, in his State of the Union speech, announced he 
would veto any health care legislation that did not provide universal 
coverage, that every citizen must be covered, I jumped to my feet and 
cheered. This was why I came to Washington, to make this kind of 
change, and this was a fight I thought we could win.
  But I had some quick learning to do. When I spoke about my interest 
in a ``single-payer'' health care plan, similar to the Canadian system 
where doctors and hospitals remain in the private sector, but where 
there is just one insurer or payer, I was told by a senior colleague 
that my plan might be the best proposal. ``But it does not have a 
chance. The insurance industry hates it and it will go nowhere. It is 
just not realistic.''
  I was completely disillusioned. I could not accept then, and I do not 
accept now, the proposition that even before the American people have 
the opportunity to be informed or included, a good proposal is ``dead 
on arrival'' because the insurance industry opposes it. That isn't 
supposed to happen in a representative democracy!
  In spite of the advice, I did introduce the single payer plan with 
Jim McDermott, a congressman and physician from the state of 
Washington. I thought first you start with the most desirable, and 
later on in the process you'll find out what is politically feasible. I 
refused to admit defeat before we had even begun to fight. And I was 
hoping that our legislation would pull the debate in a more progressive 
direction.
  What happened was just the opposite. The trillion dollar health care 
industry, led by the insurance companies, went on the attack, not 
against our plan which ``wasn't realistic'' but against the President's 
plan which ``was''. ``Harry and Louise'' ads cried out against the 
horrors of ``government medicine.'' Intensive and expensive lobbying 
efforts expounded on the same theme.
  Media coverage, which should have been about the nuts and bolts of 
different proposals shifted now to focus on strategy rather than 
substance and head counts rather than hard information. So ordinary 
citizens no longer had a source of knowledge to form opinions and 
inform their elected leaders.
  But the problems were not limited to the insurance lobby and the 
media. The only way we could have beaten the health care industry would 
have been with dramatic and effective citizen politics. It never 
happened. Progressives didn't organize a constituency to fight for 
health care reform, and the Administration didn't have the political 
will to stand up to powerful interests and therefore never asked the 
American people to take on this fight. They tried to win with ``inside 
politics,'' cutting deals and making compromises with different 
economic interests.
  With each accommodation to private power, the President's plan became 
hopelessly complicated. As a constituent told me at the time, ``How can 
you be for something you don't understand?'' What started as a noble 
effort by the President to fill a crucial national need became instead 
an object of derision.
  Over the years, as I traveled around the country talking about the 
need for Universal Health Care and the Single Payer model, I found 
people turning off--not to the need for health insurance for all, but 
to the specific mechanism I favored. They wanted universal health care, 
but they didn't want a national single payer system or they didn't 
think one was possible here, so they stopped listening.
  The mood of the country has changed since the early 1990s. In 1990, 
there were 34 million uninsured. Ten years later, today, there are 45 
million, and the number is growing by 100,000 people per month. 
Numerous polls show that the large majority of Americans want universal 
affordable comprehensive health care coverage and that they are willing 
to pay higher taxes for everyone to be covered.
  The people and the States are ahead of the Federal politicians on 
this issue. The people want a big change; not an incremental change. In 
Massachusetts and Washington state, people are pushing for ballot 
referendums in the fall on universal coverage. Massachusetts and 
Maryland have already received commissioned cost studies of alternative 
universal coverage plans. California this past fall legislated a task 
force to investigate options for universal coverage.
  Governor Howard Dean (D) of VT (also a physician), whose state 
presently covers 93.5 percent of its citizens, says it well: ``It is my 
view that health insurance ought to be universal, the right of every 
citizen in Vermont.'' And there is bipartisan support in Vermont. 
``Health care is not a partisan issue in Vermont,'' state Sen. John 
Bloomer (R) said, adding that ``it's a bipartisan goal to expand health 
care access and affordability.''
  The Health Security for All Americans Act is a plan for a big change. 
It builds on the momentum going on in the states of this great Nation.
  So I decided that rather than trying to tell people how I thought the 
system should work, what I needed to do was first, to set out what I 
have found are the common goals of the American people: universal 
affordable comprehensive health coverage; and second to provide federal 
matching funds for each state to reach those goals in the way that best 
fits the needs of that state.
  So, let me tell you about the Health Security for All Americans Act.
  First, it is based on the premise that every American--not just 
everyone in this chamber, but every American--is entitled to have 
health care coverage as good as the Congress gets. Every Federal 
employee has that right. Why shouldn't every other American?
  Second, it is based on the premise that good health care must be 
affordable. Americans should not go broke trying to keep their bodies 
fixed. From my experience traveling around the country, Americans all 
across the income spectrum are willing to be responsible for an 
affordable fair share of the cost of coverage and care, and a growing 
number of polls show that a majority of Americans are willing to pay 
higher taxes so that all Americans will have health coverage. Under the 
Health Security for All Americans Act, a family's financial 
responsibilities for health care is based on a percentage of family 
income. At the lowest end of the income scale, families would be 
responsible for no more than one-half of 1 percent of family income, so 
they can have quality health care, and a roof over their head, and 3 
square meals a day. While at the higher end of the income scale, 
families would be responsible for no more than 5 percent or 7 percent 
of family income. For example, under the Health Security for All 
Americans Act, a family of four with an annual income of $25,000 would 
be responsible for no more than $11 a month in total health care costs, 
while a family of four with $50,000 in annual income would have the 
security of knowing that its total out-of-pocket health care spending 
(premiums and cost sharing) could not exceed 5 percent of family income 
or $2500 per year.
  Third, it's based on the premise that you have to have access to care 
when you or your family needs it. That is why the Health Security for 
All Americans Act includes the Norwood-Dingell Patient Bill of Rights 
that has been endorsed by over 300 health care organizations.
  Fourth, it's based on the premise that good health care delivery 
doesn't just happen. It depends on a well trained, well compensated 
health care workforce that doesn't have to constantly worry about where 
the next dollar is coming from. And I am referring to doctors and 
nurses and orderlies and home health workers, and nursing home 
workers--all health care workers. If we are going to deliver humane 
dignified health care to everyone in this country, we need to start by 
treating the health care workforce with dignity and respect and that 
starts with affordable health care for all workers. That is why the 
Health Security for All Americans Act includes health care quality, 
patient safety, and workforce standards.

[[Page S7232]]

  My experience has taught me that Americans agree with these premises. 
They want high quality, affordable health care as good as Congress 
gets, but they are not sure the best way to get there. That is why the 
Health Security for All Americans Act is a federal state partnership 
that says here is what Americans want; you--the states--design the plan 
you want to get your state there; and we the federal government will 
provide the majority of the funds you need to reach that goal in the 
manner you chose.
  States that submit plans early and achieve universal coverage are 
rewarded with increased federal dollars for their efforts. But all 
states must have plans in force within four years and coverage for all 
their residents within five years. States could reach these goals in a 
variety of ways: with an employer mandate, with a combination of public 
and private initiatives, with single payer, or some other method. I 
think this is a good approach because it allows the states flexibility, 
but it clearly sets out a fair and just goal: Universal coverage; 
comprehensive benefits as good as Congress gets; quality care 
guaranteed with patient protections; real income protections; and 
honoring of health care workers. I am proud today to be introducing the 
Health Security for All Americans Act and I am proud that this 
legislation has the backing and support of the Service Employees 
International Union, America's largest health care union.
  To my colleagues I say, together we can put universal health care 
back on the front burner where it belongs.
  We all know that in 1994, the effort to bring health care coverage to 
all Americans failed. All of us have heard the reasons why. But what we 
haven't answered is why did we give up when we knew this was the right 
thing to do? Why have we become so timid? Why have we only been willing 
to take half steps?
  We must not shrink from the task at hand! America's doctors and 
nurses know how to cure disease better than anywhere else in the world. 
Well, now it is time to treat America's worst malady--45 million 
uninsured Americans, and millions more underinsured Americans who are 
spending far too much of their monthly pay check on health care costs.
  Martin Luther King, Jr. rightly said, ``Of all the forms of 
inequality, injustice in health care is the most shocking and 
inhumane.'' All the doctors and all the nurses and all the other health 
care providers in America cannot solve this problem nor right this 
injustice, but we in the Congress can.
  This is a problem that isn't going away on its own, but there is a 
solution. So to my colleagues, I say, ``Join me in sponsoring the 
Health Security for All Americans Act.'' And to members of the American 
public who are listening, I ask you to join thousands of your fellow 
citizens who have already written to Members of Congress, and call and 
write your Senators and Representatives and ask them to join in 
bringing quality, affordable health care coverage to all Americans.
  Mr. President, I ask unanimous consent that the bill and additional 
material be printed in the Record.
  There being no objection, the materials were ordered to be printed in 
the Record, as follows:

                                S. 2888

       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 ``Health 
     Security for All Americans Act''.
       (b) Table of Contents.--The table of contents of the Act is 
     as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.

 TITLE I--HEALTH SECURITY FOR ALL AMERICANS--EXPANSION PHASE (PHASE I)

Sec. 101. Expansion phase (phase I) voluntary State universal health 
              insurance coverage plans.

            ``TITLE XXII--HEALTH SECURITY FOR ALL AMERICANS

               ``Part A--Expansion Phase (Phase I) Plans

``Sec. 2201. Purpose; voluntary State plans.
``Sec. 2202. Plan requirements.
``Sec. 2203. Coverage requirements for expansion phase (phase I) plans.
``Sec. 2204. Allotments.
``Sec. 2205. Administration.
``Sec. 2206. Definitions.''.

TITLE II--HEALTH SECURITY FOR ALL AMERICANS--UNIVERSAL PHASE (PHASE II)

Sec. 201. Universal phase (phase II) State universal health insurance 
              coverage plans.

               ``Part B--Universal Phase (Phase II) Plans

``Sec. 2211. Purpose; mandatory State plans.
``Sec. 2212. Plan requirements.
``Sec. 2213. Coverage requirements for universal phase (phase II) 
              plans.
``Sec. 2214. Requirements for employers regarding the provision of 
              benefits.
``Sec. 2215. Allotments.
``Sec. 2216. Administration; definitions.''.
Sec. 202. Consumer protections.

                     ``Part C--Consumer Protections

``Sec. 2221. Home care standards.
``Sec. 2222. Consumer protection in the event of termination or 
              suspension of services.
``Sec. 2223. Consumer protection through disclosure of information.''.
``Sec. 2224. Consumer protection through notice of changes in health 
              care delivery.''.

                     TITLE III--PATIENT PROTECTIONS

Sec. 301. Incorporation of certain protections.

 TITLE IV--HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS

Sec. 401. Health Care Quality, Patient Safety, and Workforce Standards 
              Institute.
Sec. 402. Health Care Quality, Patient Safety, and Workforce Standards 
              Advisory Committee.

                  TITLE V--IMPROVING MEDICARE BENEFITS

Sec. 501. Full mental health and substance abuse treatment benefits 
              parity.
Sec. 502. Study and report regarding addition of prescription drug 
              benefit.

                TITLE VI--LONG-TERM AND HOME HEALTH CARE

Sec. 601. Studies and demonstration projects to identify model 
              programs.

                        TITLE VII--MISCELLANEOUS

Sec. 701. Nonapplication of ERISA.
Sec. 702. Sense of Congress regarding offsets.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) The health of the American people is the foundation of 
     American strength, productivity, and wealth.
       (2) The guarantee of health care coverage and access to 
     quality medical care to all Americans is a fundamental right 
     and is essential to the general welfare.
       (3) 45,000,000 Americans, more than 11,000,000 of whom are 
     children, have no health insurance, and that number will grow 
     to more than 54,000,000 by 2007 even if the economy remains 
     strong.
       (4) Health insurance coverage is unstable; less than \1/2\ 
     of all adults have been in their current health plan for 3 
     years.
       (5) The average American will hold at least 7 jobs during 
     their life, risking lack of health coverage every time they 
     change or are between jobs.
       (6) In 1998, annual health care expenditures in the United 
     States totaled $1,150,000,000,000, or $4,094 per person. 
     National health expenditures are projected to total 
     $2,200,000,000,000 by 2008.
       (7) In 1998, health care expenditures represented 13.5 
     percent of the gross domestic product in the United States 
     and grew at the rate of 5.6 percent while the gross domestic 
     product grew only at the rate of 4.9 percent. By 2008, health 
     care expenditures are projected to reach 16.2 percent of 
     gross domestic product. Growth in health spending is 
     projected to average 1.8 percentage points above the growth 
     rate of the gross domestic product for the period beginning 
     with 1998 and ending with 2008.
       (8) Although the United States spends considerably more in 
     health care per person than any other nation, it ranks only 
     fifteenth among countries worldwide on an overall index 
     designed to measure a range of health goals according to the 
     World Health Organization.
       (9) One of 4 adults, about 40,000,000 people, say they have 
     gone without needed medical care because they couldn't afford 
     it.
       (10) Nearly 31,000,000 Americans face collection agencies 
     annually because they owe money for medical bills.
       (11) The average American worker is paying 3 times more for 
     family coverage than 10 years ago, and more than 4 times more 
     for employee-only coverage.
       (12) Because many individuals do not have health insurance 
     coverage, they may incur health care costs which they do not 
     fully reimburse, resulting in cost-shifting to others.
       (13) As a consequence of the piecemeal health care system 
     in the United States, administrative overhead costs 
     approximately $1,000 per person annually, while other Western 
     industrialized nations with universal health care systems 
     spend approximately $200 per person annually for 
     administrative overhead.
       (14) The United States should adopt national goals of 
     universal, affordable, comprehensive health insurance 
     coverage and should provide generous matching grants to

[[Page S7233]]

     the States to achieve those goals within 5 years of the date 
     of enactment of this Act.

 TITLE I--HEALTH SECURITY FOR ALL AMERICANS--EXPANSION PHASE (PHASE I)

     SEC. 101. EXPANSION PHASE (PHASE I) VOLUNTARY STATE UNIVERSAL 
                   HEALTH INSURANCE COVERAGE PLANS.

       The Social Security Act (42 U.S.C. 301 et seq.) is amended 
     by adding at the end the following:

            ``TITLE XXII--HEALTH SECURITY FOR ALL AMERICANS

               ``PART A--EXPANSION PHASE (PHASE I) PLANS

     ``SEC. 2201. PURPOSE; VOLUNTARY STATE PLANS.

       ``(a) Purpose.--The purpose of this part is to provide 
     funds to participating States to enable those States to 
     ensure universal health insurance coverage by establishing 
     State administered systems.
       ``(b) Expansion Phase (Phase I) Plan Required.--A State is 
     not eligible for a payment under section 2205(a) unless the 
     State has submitted to the Secretary a plan that--
       ``(1) sets forth how the State intends to use the funds 
     provided under this part to ensure universal, affordable, and 
     comprehensive health insurance coverage to eligible residents 
     of the State consistent with the provisions of this part; and
       ``(2) has been approved under section 2202(d).

     ``SEC. 2202. PLAN REQUIREMENTS.

       ``(a) In General.--Every expansion phase (phase I) plan 
     shall include provisions for the following:
       ``(1) Information on the level of health insurance 
     coverage.--
       ``(A) The level of health insurance coverage within the 
     State as determined under subsection (b).
       ``(B) The base coverage gap for the year involved as 
     determined under subsection (b)(4).
       ``(C) State efforts to provide or obtain health insurance 
     coverage for uncovered residents of the State, including the 
     steps the State is taking to identify and enroll all 
     uncovered residents of the State who are eligible to 
     participate in public or private health insurance programs.
       ``(2) Details of, and timelines for, expansion phase (phase 
     i) plan.--
       ``(A) Use of funds; coordination.--The activities that the 
     State intends to carry out using funds received under this 
     part, including how the State will coordinate efforts under 
     this part with existing State efforts to increase the health 
     insurance coverage of individuals.
       ``(B) Timelines.--Consistent with subsection (c), the 
     manner in which the State will reduce the base coverage gap 
     for the year involved, including a timetable with specified 
     targets for reducing the base coverage gap by--
       ``(i) 50 percent within 2 years after the date of approval 
     of the expansion phase (phase I) plan; and
       ``(ii) 100 percent within 4 years after such date.
       ``(3) Maintenance of effort.--The manner in which the State 
     will ensure that--
       ``(A) employers within the State will continue to provide 
     not less than the level of financial support toward the 
     health insurance premiums required for coverage of their 
     employees as such employers provided as of the date of 
     enactment of this title; and
       ``(B) the State will continue to provide not less than the 
     level of State expenditures incurred for State-funded health 
     programs as of such date.
       ``(4) State outreach programs; access.--The manner in 
     which, and a timetable for when, the State will--
       ``(A) institute outreach programs; and
       ``(B) ensure that all eligible residents of the State have 
     access to the health insurance coverage provided under this 
     part.
       ``(5) Assurance of coverage of essential services.--An 
     assurance that the State program established under this part 
     will comply with the requirements of section 1867 (commonly 
     referred to as the `Emergency Medical Treatment and Active 
     Labor Act').
       ``(6) Representation on boards and commissions.--The manner 
     in which the State will ensure that all Boards and 
     Commissions that the State establishes to administer the plan 
     will include, among others, representatives of providers, 
     consumers, employers, and health worker unions.
       ``(7) Disclosure of information to the public.--The manner 
     in which the State will ensure that, with respect to entities 
     and individuals that provide services for which reimbursement 
     is provided under this part--
       ``(A) financial arrangements between insurers and providers 
     and between providers and medical equipment suppliers are 
     disclosed to the public; and
       ``(B) ownership interests and health care worker 
     qualifications and credentials are disclosed to the public.
       ``(8) Consumer protections.--The manner in which the State 
     will ensure compliance with sections 2221, 2222, 2223, and 
     2224.
       ``(9) Public review.--The manner in which the State will 
     provide for the public review of institutional changes in 
     services provided, markets and regions covered, withdrawal or 
     movement of services, closures or downsizing, and other 
     actions that affect the provision of health insurance under 
     the plan.
       ``(10) Services in rural and underserved areas; cultural 
     competency.--The manner in which the State will ensure--
       ``(A) coverage in rural and underserved areas; and
       ``(B) that the needs of culturally diverse populations are 
     met.
       ``(11) Purchasing pools.--The manner in which the State 
     will encourage the formation of State purchasing pools that 
     provide choice of health plans, control costs, and reduce 
     adverse risk selection.
       ``(12) Limitation on administrative expenditures.--The 
     manner in which the State will ensure that all qualified 
     plans in the State expend at least 90 percent (or, during the 
     first 2 years of the plan, 85 percent) of total income 
     received from premiums on the provision of covered health 
     care benefits (excluding all costs for marketing, 
     advertising, health plan administration, profits, or capital 
     accumulation) to individuals.
       ``(13) Self-employed and multiemployed.--The manner in 
     which the State will address self-employed individuals and 
     multiwage earner families.
       ``(14) Medicaid wraparound coverage.--The manner in which 
     the State will ensure that individuals who are eligible for 
     medical assistance under title XIX and who receive benefits 
     under the expansion phase (phase I) plan shall receive any 
     items or services that are not available under the expansion 
     phase (phase I) plan but that are available under the State 
     medicaid program under title XIX through `wraparound 
     coverage' under such program.
       ``(15) Other matters.--Any other matter determined 
     appropriate by the Secretary.
       ``(b) Current Level of Coverage.--
       ``(1) In general.--The Secretary shall develop a survey 
     approach that provides timely and up-to-date data to 
     determine the percentage of the population of each State that 
     is currently covered by a health insurance plan or program 
     that provides coverage that meets the requirements of section 
     2203(a).
       ``(2) Biannual survey.--The Secretary shall provide for the 
     conduct of the survey developed under paragraph (1) not less 
     than biannually to make coverage determinations for purposes 
     of paragraph (1).
       ``(3) Use of alternative system.--The Secretary shall 
     permit a State to utilize an alternative population-based 
     monitoring system to make determinations with respect to 
     coverage in the State for purposes of paragraph (1) if the 
     Secretary determines that such system meets or exceeds the 
     methodological standards utilized in the survey developed 
     under paragraph (1).
       ``(4) Base coverage gap.--For purposes of subsection 
     (a)(1)(A), the base coverage gap for a State shall be equal 
     to 100 percent of the eligible individuals and families in 
     the State for the year involved, less the current level of 
     coverage for those individuals and families for such year as 
     determined under paragraph (1) or (3).
       ``(c) Reducing the Level of Uninsured Individuals.--
       ``(1) In general.--To be eligible to receive funds under 
     this part, a State shall agree to administer an expansion 
     phase (phase I) plan with a goal of providing health 
     insurance coverage for 100 percent of the eligible residents 
     of the State by not later than 4 years after the date of 
     approval of the State's expansion phase (phase I) plan.
       ``(2) Permissible activities.--A State may use amounts 
     provided under this part for any activities consistent with 
     this part that are appropriate to enroll individuals in 
     health plans and health programs to meet the targets 
     contained in the State plan under subsection (a)(2)(B), 
     including through the use of direct payments to health plans 
     or, in the case of a single State plan, directly to providers 
     of services.
       ``(d) Process for Submission, Approval, and Amendment of 
     Expansion Phase (Phase I) Plan.--The provisions of section 
     2106 apply to an expansion phase (phase I) plan under this 
     part in the same manner as they apply to a State plan under 
     title XXI, except that no expansion phase (phase I) plan may 
     be effective earlier than January 1, 2001, and all expansion 
     phase (phase I) plans must be submitted for approval by not 
     later than December 31, 2002.

     ``SEC. 2203. COVERAGE REQUIREMENTS FOR EXPANSION PHASE (PHASE 
                   I) PLANS.

       ``(a) Required Scope of Health Insurance Coverage.--Health 
     insurance coverage provided under this part shall consist of 
     at least the benefits provided under the Federal Employees 
     Health Benefits Program standard Blue Cross/Blue Shield 
     preferred provider option service benefit plan, described in 
     and offered under section 8903(1) of part 5, United States 
     Code, including mental health and substance abuse treatment 
     benefits parity.
       ``(b) Limitations on Premiums and Cost-Sharing.--
       ``(1) Description; general conditions.--An expansion phase 
     (phase I) plan shall include a description, consistent with 
     this subsection, of the amount (if any) of premiums, cost-
     sharing, or other similar charges imposed. Any such charges 
     shall be imposed pursuant to a public schedule.
       ``(2) Limitations on premiums and cost-sharing.--
       ``(A) Individuals and families with income below 150 
     percent of poverty line.--In the case of an individual or 
     family whose income is at or below 150 percent of the poverty 
     line--
       ``(i) the State plan may not impose a premium; and
       ``(ii) the total annual aggregate amount of cost-sharing 
     imposed by a State with respect to all individuals in a 
     family may not exceed 0.5 percent of the family's income for 
     the year involved.

[[Page S7234]]

       ``(B) Individuals and families with income between 150 and 
     300 percent of poverty line.--In the case of an individual or 
     family whose income exceeds 150 percent but does not exceed 
     300 percent of the poverty line--
       ``(i) the State plan may not impose a premium that exceeds 
     an amount that is equal to--

       ``(I) 20 percent of the average cost of providing benefits 
     to an individual (or a family) under this part in the year 
     involved; or
       ``(II) 3 percent of the family's income for the year 
     involved; and

       ``(ii) the total annual aggregate amount of premiums and 
     cost-sharing (combined) imposed by a State with respect to 
     all individuals in a family may not exceed 5 percent of the 
     family's income for the year involved.
       ``(C) Individuals and families with income above 300 
     percent of poverty line.--In the case of an individual or 
     family whose income exceeds 300 percent of the poverty line--
       ``(i) the State plan may not impose a premium that exceeds 
     20 percent of the average cost of providing benefits to an 
     individual (or a family of the size involved) under this part 
     in the year involved; and
       ``(ii) the total annual aggregate amount of premiums and 
     cost-sharing (combined) imposed by a State with respect to 
     all individuals in a family may not exceed 7 percent of the 
     family's income for the year involved.
       ``(D) Self-employed individuals.--The State shall establish 
     rules for self-employed individuals based on individual and 
     family income.
       ``(3) Collection.--The State shall establish procedures for 
     collecting any premiums, cost-sharing, or other similar 
     charges imposed under this part. Such procedures shall 
     provide for annual reconciliations and adjustments.
       ``(c) Application of Certain Requirements.--
       ``(1) Restriction on application of preexisting condition 
     exclusions.--The expansion phase (phase I) plan shall not 
     permit the imposition of any preexisting condition exclusion 
     for covered benefits under the plan.
       ``(2) Choice of plans.--
       ``(A) In general.--Except as provided in subparagraph (B), 
     the expansion phase (phase I) plan shall offer eligible 
     individuals and families a choice of qualified plans from 
     which to receive benefits under this part. At least 1 plan 
     shall be a preferred provider option plan.
       ``(B) Waiver.--The Secretary--
       ``(i) may waive the requirement under subparagraph (A) if 
     determined appropriate; and
       ``(ii) shall waive such requirement in the case of a State 
     that establishes a single State plan.

     ``SEC. 2204. ALLOTMENTS.

       ``(a) State Allotments.--
       ``(1) In general.--With respect to a fiscal year, the 
     Secretary shall allot to each State with an expansion phase 
     (phase I) plan approved under this part the amount determined 
     under paragraph (2) for such State for such fiscal year.
       ``(2) Determination of cost of coverage.--The amount 
     determined under this paragraph is the amount equal to--
       ``(A) the product of--
       ``(i) the Federal participation rate for the State as 
     determined under subsection (b) or, if applicable, the 
     enhanced Federal participation rate for the State, as 
     determined under subsection (c);
       ``(ii) the estimated cost for the minimum benefits package 
     required to comply under section 2203, not to exceed the sum 
     of--

       ``(I) the total annual Government and employee 
     contributions required for individual or self and family 
     health benefits coverage under the Federal Employees Health 
     Benefits Program standard Blue Cross/Blue Shield preferred 
     provider option service benefit plan, described in and 
     offered under section 8903(1) of title 5, United States Code 
     (adjusted for age, as the Secretary determines appropriate); 
     and
       ``(II) the estimated average cost-sharing expense for an 
     individual or family; and

       ``(iii) the estimated number of residents to be enrolled in 
     the expansion phase (phase I) plan; less
       ``(B) the sum of--
       ``(i) the individual or family health insurance 
     contribution and cost-sharing payments to be made in 
     accordance with section 2203(b); and
       ``(ii) any applicable employer contribution to such 
     payments.
       ``(b) Federal Participation Rate.--For purposes of 
     subsection (a)(2)(A)(i), the Federal participation rate for a 
     State shall be equal to the enhanced FMAP determined for the 
     State under section 2105(b).
       ``(c) Enhanced Federal Participation Rate.--
       ``(1) In general.--For purposes of subsection (a)(2)(A)(i), 
     the enhanced Federal participation rate for a State shall be 
     equal to the Federal participation rate for such State under 
     subsection (b), as adjusted by the Secretary based on the 
     decrease in the base coverage gap in the State.
       ``(2) Amount of adjustment and application.--
       ``(A) Amount of adjustment.--The Federal participation rate 
     under subsection (b) with respect to a State shall be 
     increased by--
       ``(i) 1 percentage point if the base coverage gap of the 
     State has decreased by at least 50 percent within 2 years 
     after the date of approval of the expansion phase (phase I) 
     plan, as determined by the Secretary; and
       ``(ii) 3 percentage points if the base coverage gap of the 
     State has decreased by 100 percent within 4 years after the 
     date of approval of the expansion phase (phase I) plan, as 
     determined by the Secretary.
       ``(B) Application.--The increase described in--
       ``(i) subparagraph (A)(i) shall only apply to a State for 
     the period beginning with the month of the determination 
     under such subparagraph and ending with the month preceding 
     the month of the determination under subparagraph (A)(ii) (if 
     any), but in no event for more than 24 months; and
       ``(ii) subparagraph (A)(ii) shall apply to a State for any 
     year (or portion thereof) beginning with the month of the 
     determination under such subparagraph.
       ``(3) Full coverage.--For purposes of this part, a State 
     shall be deemed to have decreased its base coverage gap by 
     100 percent if the Secretary determines that--
       ``(A) 98 percent of all eligible residents of the State are 
     provided health insurance coverage under the expansion phase 
     (phase I) plan; and
       ``(B) the remaining 2 percent of such residents are served 
     by alternative health care delivery systems as demonstrated 
     by the State.
       ``(d) Grants to Indian Tribes, Native Hawaiian 
     Organizations, and Alaska Native Organizations.--
       ``(1) In general.--Out of funds appropriated under 
     subsection (e), the Secretary shall reserve an amount, not to 
     exceed 1 percent of the total allotments determined under 
     subsection (a) for a fiscal year, to make grants to Indian 
     tribes, Native Hawaiian organizations, and Alaska Native 
     organizations for development and implementation of universal 
     health insurance coverage plans for members of such tribes 
     and organizations.
       ``(2) Plan.--To be eligible to receive a grant under 
     paragraph (1), an Indian tribe, Native Hawaiian organization, 
     or Alaska Native organization shall submit a universal health 
     insurance coverage plan to the Secretary at such time, in 
     such manner, and containing such information, as the 
     Secretary may require.
       ``(3) Regulations.--The Secretary shall issue regulations 
     specifying the requirements of this part that apply to Indian 
     tribes, Native Hawaiian organizations, and Alaska Native 
     organizations receiving grants under paragraph (1).
       ``(e) Appropriation.--
       ``(1) In general.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to carry out 
     this title such sums as may be necessary for fiscal year 2001 
     and each fiscal year thereafter.
       ``(2) Budget authority.--Paragraph (1) constitutes budget 
     authority in advance of appropriations Acts and represents 
     the obligation of the Federal Government to provide States, 
     Indian tribes, Native Hawaiian organizations, and Alaska 
     Native organizations with the allotments determined under 
     this section and the grants for administrative and outreach 
     activities under section 2205.

     ``SEC. 2205. ADMINISTRATION.

       ``(a) Payments.--
       ``(1) In general.--
       ``(A) Quarterly.--Subject to subparagraph (B) and 
     subsection (b), the Secretary shall make quarterly payments 
     to each State with an expansion phase (phase I) plan approved 
     under this part, from its allotment under section 2204.
       ``(B) Funding for administration and outreach.--
       ``(i) Authority to make grants.--In addition to the 
     allotments determined under section 2204, the Secretary may 
     make grants to States, Indian tribes, Native Hawaiian 
     organizations, and Alaska Native organizations for 
     expenditures for administrative and outreach activities.
       ``(ii) Amounts.--

       ``(I) In general.--A grant awarded under this subparagraph 
     shall not exceed the applicable percentage (as determined 
     under subclause (II)) of the total amount allotted to the 
     State, Indian tribe, Native Hawaiian organization, or Alaska 
     Native organization under section 2204.
       ``(II) Applicable percentage.--For purposes of subclause 
     (I), the applicable percentage is--

       ``(aa) 14 percent during the first 2 years an expansion 
     phase (phase I) plan is in effect and complies with the 
     requirements of this title;
       ``(bb) 12 percent during the third, fourth, and fifth years 
     that such plan, or a universal phase (phase II) plan added by 
     an addendum to an expansion phase (phase I) plan, is in 
     effect and complies with the requirements of this title; and
       ``(cc) 10 percent during any year thereafter such plan (or 
     universal phase (phase II) plan added by an addendum to such 
     plan) is in effect and complies with the requirements of this 
     title.
       ``(2) Advance payment; retrospective adjustment.--The 
     Secretary may make payments under this part for each quarter 
     on the basis of advance estimates by the State and such other 
     investigation as the Secretary may find necessary, and may 
     reduce or increase the payments as necessary to adjust for 
     any overpayment or underpayment for prior quarters.
       ``(3) Flexibility in submittal of claims.--Nothing in this 
     subsection shall be construed as preventing a State from 
     claiming as expenditures in the quarter expenditures that 
     were incurred in a previous quarter.

[[Page S7235]]

       ``(b) Authority for Blended Rate for Health Security, 
     Medicaid, and SCHIP Funds.--The Secretary shall establish 
     procedures for blending the payments that a State is entitled 
     to receive under this title, title XIX, and title XXI into 1 
     payment rate if--
       ``(1) the State requests such a blended payment; and
       ``(2) the Secretary finds that the State meets maintenance 
     of effort requirements established by the Secretary.
       ``(c) Limitations on Federal Payments Based on Cost 
     Containment.--
       ``(1) Determination of baseline.--Each year (beginning with 
     2001), the Secretary shall establish a baseline projection 
     for the national rate of growth in private health insurance 
     premiums for such year.
       ``(2) Requirement.--Beginning with fiscal year 2002 and 
     each fiscal year thereafter, any payment made to a State 
     under section 2204 shall not exceed the amount paid to the 
     State under such section for the preceding fiscal year, 
     adjusted for changes in enrollment and a premium inflation 
     adjustment that is 0.5 percent below the baseline projection 
     determined under paragraph (1) for the year.
       ``(d) Other Limitations On Use of Funds.--
       ``(1) In general.--A State participating under part A, and, 
     effective January 1, 2005, all States under part B, shall 
     ensure that any payments received by the State under section 
     2205 or 2116(a) are not used by any individual or entity, 
     including providers or health plans that contract to provide 
     services herein, to finance directly or indirectly, or to 
     otherwise facilitate expenditures to influence health care 
     workers of such individual or entity with respect to issues 
     related to unionization.
       ``(2) Construction.--Nothing in this subsection shall be 
     construed to limit expenditures made for the purpose of good 
     faith collective bargaining or pursuant to the terms of a 
     bona fide collective bargaining agreement.
       ``(e) Waiver of Federal Requirements.--A State may request 
     (and the Secretary may grant) a waiver of any provision of 
     Federal law that the State determines is necessary in order 
     to carry out an approved expansion phase (phase I) plan under 
     this part.
       ``(f) Report.--Not later than January 1, 2002, and each 
     January 1 thereafter, the Secretary, in consultation with the 
     General Accounting Office and the Congressional Budget 
     Office, shall prepare and submit to the appropriate 
     committees of Congress a report on the number of States 
     receiving payments under this part for the year for which the 
     report is being prepared as well as the level of insurance 
     coverage attained by each such State.

     ``SEC. 2206. DEFINITIONS.

       ``In this title:
       ``(1) Cost-sharing.--The term `cost-sharing' has the 
     meaning given such term under the Federal Employees Health 
     Benefits Program standard Blue Cross/Blue Shield preferred 
     provider option service benefit plan described in and offered 
     under section 8903(1) of part 5, United States Code, and 
     includes deductibles, copayments, coinsurance, as such terms 
     are defined for purposes of such plan.
       ``(2) Eligible residents of a state.--
       ``(A) In general.--The term `eligible residents of a State' 
     means an individual or family who--
       ``(i) is (or consists of) a resident of the State involved;
       ``(ii) except as provided in subparagraph (B), has a family 
     income that does not exceed 300 percent of the poverty line;
       ``(iii) is (or consists of) a citizen of the United States, 
     a legal resident alien, or an individual otherwise residing 
     in the United States under the authority of Federal law; and
       ``(iv) in the case of an individual, is not eligible for 
     benefits under the medicare program under title XVIII or for 
     medical assistance under the medicaid program under title XIX 
     (other than under the application of section 
     1902(a)(10)(A)(ii)(XIV)).
       ``(B) Option to provide coverage for individuals and 
     families with higher income.--If approved by the Secretary, a 
     State may increase the percentage described in subparagraph 
     (A)(ii), or eliminate all income eligibility criteria in 
     order to provide coverage under this part to more individuals 
     and families.
       ``(3) Expansion phase (phase i) plan.--The term `expansion 
     phase (phase I) plan' means the State universal health 
     insurance coverage plan submitted under section 2201(b).
       ``(4) Health care services.--The term `health care 
     services' includes medical, surgical, mental health, and 
     substance abuse services, whether provided on an in-patient 
     or outpatient basis.
       ``(5) Health care worker.--The term `health care worker' 
     means an individual employed by an employer that provides--
       ``(A) health care services; or
       ``(B) necessary related services, including administrative, 
     food service, janitorial, or maintenance service to an entity 
     that provides such health care services.
       ``(6) Health plan.--The term `health plan' includes health 
     insurance coverage, as defined in section 2791(b)(1) of the 
     Public Health Service Act (42 U.S.C. 300gg-91(b)(1)) and 
     group health plans, as defined in section 2791(a) of such Act 
     (42 U.S.C. 300gg91(b)(1)).
       ``(7) Mental health and substance abuse treatment benefits 
     parity.--
       ``(A) In general.--The term `mental health and substance 
     abuse treatment benefits parity' means the same level of 
     parity for such benefits as is required under the Federal 
     Employees Health Benefits Program standard Blue Cross/Blue 
     Shield preferred provider option service benefit plan, 
     described in and offered under section 8903(1) of part 5, 
     United States Code, as of January 1, 2001.
       ``(B) Exception.--Notwithstanding subparagraph (A), there 
     shall be no limit on parity benefits for patients who do not 
     substantially follow their treatment plans unless such limits 
     also are imposed on all medical and surgical benefits.
       ``(8) Poverty line.--The term `poverty line' has the 
     meaning given such term in section 673(2) of the Community 
     Services Block Grant Act (42 U.S.C. 9902(2)), including any 
     revision required by such section.
       ``(9) Premium.--The term `premium' includes any enrollment 
     fees and other similar charges.
       ``(10) Qualified plan.--The term `qualified plan' means a 
     health plan that satisfies the coverage requirements 
     described under section 2203 and participates in an expansion 
     phase (phase I) plan.''.

TITLE II--HEALTH SECURITY FOR ALL AMERICANS--UNIVERSAL PHASE (PHASE II)

     SEC. 201. UNIVERSAL PHASE (PHASE II) STATE UNIVERSAL HEALTH 
                   INSURANCE COVERAGE PLANS.

       Title XXII of the Social Security Act, as added by section 
     101, is amended by adding at the end the following:

               ``PART B--UNIVERSAL PHASE (PHASE II) PLANS

     ``SEC. 2211. PURPOSE; MANDATORY STATE PLANS.

       ``(a) Purpose.--The purposes of this part are to--
       ``(1) require States to establish and implement State-
     administered systems to ensure universal health insurance 
     coverage; and
       ``(2) provide funds to States for the establishment and 
     implementation of such systems.
       ``(b) Universal Phase (Phase II) Plan Required.--
       ``(1) In general.--Except as provided in paragraph (2), not 
     later than January 1, 2004, a State shall submit to the 
     Secretary a plan that sets forth how the State intends to use 
     the funds provided under this part to ensure universal, 
     affordable, and comprehensive health insurance coverage to 
     eligible residents of the State consistent with the 
     provisions of this part.
       ``(2) States with phase i plans.--
       ``(A) In general.--Not later than January 1, 2004, a State 
     with a phase I State plan shall submit an addendum to such 
     plan that provides assurances to the Secretary that such plan 
     conforms to the requirements of this part.
       ``(B) Conversion to universal phase (phase ii) plan.--If an 
     addendum to an expansion phase (phase I) plan is approved by 
     the Secretary--
       ``(i) the plan shall be automatically converted to a 
     universal phase (phase II) plan; and
       ``(ii) section 2214 and any provision of part A that is 
     inconsistent with this part shall not apply to the plan.
       ``(3) Failure to submit plan or addendum.--If a State fails 
     to submit a plan as required in paragraph (1) (or an addendum 
     as required in paragraph (2)), or fails to have such plan or 
     addendum approved by the Secretary, such State shall be in 
     violation of this part; and any residents of such a State may 
     bring a cause of action against the State in Federal district 
     court to require the State to comply with the provisions of 
     this part.

     ``SEC. 2212. PLAN REQUIREMENTS.

       ``(a) In General.--A universal phase (phase II) plan shall 
     include a description, consistent with the requirements of 
     this part, of the following:
       ``(1) Details of the universal phase (phase ii) plan.--The 
     activities that the State intends to carry out using funds 
     received under this part to ensure that all eligible 
     residents of the State have access to the coverage provided 
     under this part, including how the State will coordinate 
     efforts under the program under this part with existing State 
     efforts to increase to 100 percent the health insurance 
     coverage of eligible residents of the State by January 1, 
     2006.
       ``(2) Requirements for employers.--The manner in which the 
     State will ensure that employers within the State will comply 
     with the requirements of section 2214.
       ``(3) Part a provisions.--The following provisions apply to 
     a universal phase (phase II) plan under this part in the same 
     manner as such provisions apply to an expansion phase (phase 
     I) plan under part A:
       ``(A) State outreach programs; access.--Section 2202(a)(4).
       ``(B) Assurance of coverage of essential services.--Section 
     2202(a)(5).
       ``(C) Representation on boards and commissions.--Section 
     2202(a)(6).
       ``(D) Disclosure of information to the public.--Section 
     2202(a)(7).
       ``(E) Consumer protections and workforce standards.--
     Section 2202(a)(8).
       ``(F) Public review.--Section 2202(a)(9).
       ``(G) Services in rural and underserved areas; cultural 
     competency.--Section 2202(a)(10).
       ``(H) Purchasing pools.--Section 2202(a)(11).
       ``(I) Limitation on administrative expenditures.--Section 
     2202(a)(12).
       ``(J) Self-employed and multiemployed.--Section 
     2202(a)(13).

[[Page S7236]]

       ``(K) Medicaid wraparound coverage.--Section 2202(a)(14).
       ``(4) Other matters.--Any other matter determined 
     appropriate by the Secretary.
       ``(b) Permissible Activities.--A State may use amounts 
     provided under this part for any activities consistent with 
     this part that are appropriate to enroll individuals in 
     health plans to ensure that all eligible residents of the 
     State are provided coverage under this part, including 
     through the use of direct payments to health plans or 
     providers of services.
       ``(c) Cost Containment; Competitive Bidding.--
     Notwithstanding subsection (b), State purchasing pools shall 
     solicit bids from health plans at least annually.
       ``(d) Process for Submission, Approval, and Amendment of 
     Universal Phase (Phase II) Plan.--Section 2106 applies to a 
     universal phase (phase II) plan under this part in the same 
     manner as such section applies to a State plan under title 
     XXI, except that no universal phase (phase II) plan may be 
     effective earlier than January 1, 2005, and all such plans 
     must be submitted for approval by not later than January 1, 
     2004.

     ``SEC. 2213. COVERAGE REQUIREMENTS FOR UNIVERSAL PHASE (PHASE 
                   II) PLANS.

       ``(a) Required Scope of Health Insurance Coverage.--Section 
     2203(a) applies to a universal phase (phase II) plan under 
     this part.
       ``(b) Universal Coverage.--All States shall ensure that by 
     January 1, 2006, 100 percent of eligible residents of the 
     State have health insurance coverage that meets the 
     requirements of section 2203(a).
       ``(c) Limitations on Premiums and Cost-Sharing.--Section 
     2203(b) applies to a universal phase (phase II) plan under 
     this part.
       ``(d) Application of Certain Requirements.--Section 2203(c) 
     applies to a universal phase (phase II) plan under this part.

     ``SEC. 2214. REQUIREMENTS FOR EMPLOYERS REGARDING THE 
                   PROVISION OF BENEFITS.

       ``(a) Requirements.--Subject to subsection (c)(2)(B), an 
     employer in a State shall comply with the following 
     requirements:
       ``(1) Employers with less than 500 employees.--
       ``(A) In general.--An employer with less than 500 employees 
     shall enroll each employee in a State-designated purchasing 
     pool.
       ``(B) Contributions.--
       ``(i) In general.--Notwithstanding subparagraph (A) and 
     subject to clause (ii), the employer shall make a 
     contribution on behalf of each employee for health insurance 
     coverage that is equal to at least 80 percent of the total 
     premiums for such coverage for employees and their families 
     if the employee elects dependent coverage.
       ``(ii) Limitation.--An employer shall not be liable under 
     subparagraph (B) for more than 10 percent of each employee's 
     annual wages.
       ``(2) Employers with at least 500 employees.--
       ``(A) In general.--An employer with at least 500 employees, 
     a majority of whose wages fall below an amount equal to 300 
     percent of the poverty line applicable to a family of the 
     size involved, shall comply with the requirements applicable 
     to an employer under paragraph (1).
       ``(B) Other employers.--
       ``(i) In general.--An employer with at least 500 employees 
     that is not described in subparagraph (A) shall, at the 
     option of the employer, either--

       ``(I) comply with the requirements applicable to an 
     employer under paragraph (1); or
       ``(II) provide health insurance coverage to all employees 
     and their families (if the employee elects dependent 
     coverage) that meets the requirements of section 2213 and the 
     employer contribution required under paragraph (1)(B).

       ``(ii) Additional employer contribution.--An employer that 
     elects to comply with clause (i)(I) shall contribute an 
     additional 1 percent of payroll into the State-designated 
     purchasing pool in which it participates.
       ``(3) Rule of construction.--Nothing in this title shall be 
     construed as prohibiting a labor organization from 
     collectively bargaining for an employer contribution that is 
     greater than the contribution that is required under 
     paragraph (1)(B) or, as applicable, for health insurance 
     benefits that are greater than the coverage required under 
     paragraph section 2203(a).
       ``(4) Part-time employees.--An employer shall be 
     responsible for meeting the requirements under this 
     subsection for all employees of the employer.
       ``(5) Multiemployer families.--In the case of a family with 
     more than 1 employer, the employers of individuals within the 
     family shall apportion their contributions in accordance with 
     rules established by the State.
       ``(b) Nonapplicability.--This section shall not apply--
       ``(1) to any State that establishes a single payor system; 
     or
       ``(2) to any State that established a universal phase 
     (phase II) plan through an approved addendum to an expansion 
     phase (phase I) plan.
       ``(c) Private Cause of Action.--
       ``(1) Liability.--An employer that fails to comply with the 
     requirements of subsection (a) or otherwise takes adverse 
     action against an employee for the purpose of interfering 
     with the attainment of any right to which the employee may be 
     entitled to under this title, shall be liable to the employee 
     affected.
       ``(2) Amount.--The amount of the liability described in 
     paragraph (1) shall be an amount equal to--
       ``(A) the contributions that otherwise would have been made 
     by the employer on behalf of the employee under this section;
       ``(B) an additional amount as liquidated damages; and
       ``(C) consequential damages for reasonably foreseeable 
     injuries resulting from such action.
       ``(3) Jurisdiction; equitable relief.--
       ``(A) Jurisdiction.--An action under this subsection may be 
     maintained against any employer in any Federal or State court 
     of competent jurisdiction by any 1 or more employees.
       ``(B) Equitable relief.--In addition to the damages 
     described in paragraph (2), a court may enjoin any act or 
     practice that violates this title.
       ``(4) Attorney's fees.--If a plaintiff or plaintiffs 
     prevail in an action brought under this subsection, the court 
     shall, in addition to any judgment awarded to the plaintiff 
     or plaintiffs, award the reasonable attorney's fees and costs 
     associated with the bringing of the action.

     ``SEC. 2215. ALLOTMENTS.

       ``(a) State Allotments.--Subsections (a) and (b) of section 
     2204 apply to a universal phase (phase II) plan under this 
     part in the same manner as such subsections apply to an 
     expansion phase (phase I) plan under part A.
       ``(b) Special Rule for Expansion Phase (Phase I) Plans.--A 
     State that operated an expansion phase (phase I) plan and 
     converted such plan to a universal phase (phase II) plan 
     pursuant to section 2211(b)(2)(B) shall continue to be 
     eligible for the enhanced Federal participation rate 
     determined under section 2204(c).
       ``(c) Grants to Indian Tribes, Native Hawaiian 
     Organizations, and Alaska Native Organizations.--Section 
     2204(d) applies to a universal phase (phase II) plan under 
     this part.
       ``(d) Appropriation.--
       ``(1) In general.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to carry out 
     this title such sums as may be necessary for fiscal year 2005 
     and each fiscal year thereafter.
       ``(2) Budget authority.--Paragraph (1) constitutes budget 
     authority in advance of appropriations Acts and represents 
     the obligation of the Federal Government to provide States, 
     Indian tribes, Native Hawaiian organizations, and Alaska 
     Native organizations with the allotments determined under 
     this section and the grants for administrative and outreach 
     activities under section 2205(a)(1)(B) (as applied to this 
     part under section 2216(a)).

     ``SEC. 2216. ADMINISTRATION; DEFINITIONS.

       ``(a) Administration.--The provisions of section 2205 
     (other than subsection (c) of such section) apply to a 
     universal phase (phase II) plan under this part in the same 
     manner as such provisions apply to an expansion phase (phase 
     I) plan under part A.
       ``(b) Definitions.--
       ``(1) Application of section 2206.--The definitions set 
     forth in section 2206 apply to a universal phase (phase II) 
     plan under this part in the same manner as such provisions 
     apply to an expansion phase (phase I) plan under part A 
     except that for purposes of this part, the definition of 
     `eligible residents of a State' set forth in section 2206(2) 
     shall be applied without regard to subparagraphs (A)(ii) and 
     (B).
       ``(2) Universal phase (phase ii ) plan.--In this title, the 
     term `universal phase (phase II) plan' means the State 
     universal health insurance coverage plan submitted under 
     section 2211(b).''.

     SEC. 202. CONSUMER PROTECTIONS.

       Title XXII of the Social Security Act, as amended by 
     section 201, is amended by adding at the end the following:

                     ``PART C--CONSUMER PROTECTIONS

     ``SEC. 2221. HOME CARE STANDARDS.

       ``In order to ensure that home care services are provided 
     in a consumer-directed manner, a State participating under 
     part A, and, effective January 1, 2005, all States under part 
     B, shall satisfy the Secretary that any health plan that 
     provides home care services under this title creates, or 
     contracts with, a viable entity other than the consumer or 
     individual provider to provide effective billing, payments 
     for services, tax withholding, unemployment insurance, and 
     workers compensation coverage, and to serve as the statutory 
     employer of the home care provider. Recipients of such 
     services shall retain the right to independently select, 
     hire, terminate, and direct the work of the home care 
     provider.

     ``SEC. 2222. CONSUMER PROTECTION IN THE EVENT OF TERMINATION 
                   OR SUSPENSION OF SERVICES.

       ``A State participating under part A, and, effective 
     January 1, 2005, all States under part B, shall satisfy the 
     Secretary that any health plan providing services under this 
     title shall ensure that enrollees will receive continued 
     health services in the event that the plan's health care 
     services are terminated or suspended, including as the result 
     of the plan filing for bankruptcy relief under title 11, 
     United States Code, or the failure of the plan to provide 
     payments to providers, lockouts, work stoppages, or other 
     labor management problems.

     ``SEC. 2223. CONSUMER PROTECTION THROUGH DISCLOSURE OF 
                   INFORMATION.

       ``(a) In General.--A State participating under part A, and, 
     effective January 1, 2005,

[[Page S7237]]

     all States under part B, shall satisfy the Secretary that any 
     health care provider that provides services to individuals 
     under this title shall provide to the State information 
     regarding the identity, employment location, and 
     qualifications of health care workers providing services 
     under--
       ``(1) the licensure of the provider; or
       ``(2) a contract between the provider and a health plan or 
     the State.
       ``(b) Availability to Public.--A health care provider shall 
     make the information described in subsection (a) available to 
     the public.''.

     ``SEC. 2224. CONSUMER PROTECTION THROUGH NOTICE OF CHANGES IN 
                   HEALTH CARE DELIVERY.

       ``A State participating under part A, and, effective 
     January 1, 2005, all States under part B, shall describe how 
     the State will provide, at a minimum, the following 
     protections:
       ``(1) Adequate advance notice to the public, the affected 
     health care workers, and labor organizations representing 
     such workers, of a pending--
       ``(A) facility or operating unit closure;
       ``(B) sale, merger, or consolidation of a facility or 
     operating unit;
       ``(C) transfer of work from 1 facility or entity to another 
     facility or entity; or
       ``(D) reduction of services.
       ``(2) A right of first refusal for similar vacant positions 
     with--
       ``(A) the resulting entity, in the case of a health care 
     worker whose position was eliminated following a merger of 
     the worker's original employer with a new entity; or
       ``(B) the contractor, in the case of a health care worker 
     whose position was eliminated following the contracting out 
     of the work the worker formerly performed.''.

                     TITLE III--PATIENT PROTECTIONS

     SEC. 301. INCORPORATION OF CERTAIN PROTECTIONS.

       (a) Incorporation.--The provisions of the following bills 
     are hereby enacted into law:
       (1) H.R. 2723 of the 106th Congress (other than section 
     135(b)), as introduced on August 5, 1999.
       (2) H.R. 137 of the 106th Congress, as introduced on 
     January 6, 1999.
       (b) Publication.--In publishing this Act in slip form and 
     in the United States Statutes at Large pursuant to section 
     112, of title 1, United States Code, the Archivist of the 
     United States shall include after the date of approval at the 
     end appendixes setting forth the texts of the bills referred 
     to in subsection (a) of this section.

 TITLE IV--HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS

     SEC. 401. HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE 
                   STANDARDS INSTITUTE.

       (a) Establishment.--
       (1) Institute.--There is established within the Agency for 
     Healthcare Research and Quality, an institute to be known as 
     the Health Care Quality, Patient Safety, and Workforce 
     Standards Institute (in this section referred to as the 
     ``Institute'').
       (2) Director.--The Secretary of Health and Human Services 
     shall appoint a director of the Institute. The director shall 
     administer the Institute and carry out the duties of the 
     director under this section subject to the authority, 
     direction, and control of the Secretary.
       (b) Mission.--The mission of the Institute is to--
       (1) demonstrate how patient safety issues and workplace 
     conditions are linked to quality patient care and the 
     reduction of the incidence of medical errors; and
       (2) reduce the incidence of medical errors and improve 
     patient safety and quality of care.
       (c) Duties.--In carrying out the mission of the Institute, 
     the director of the Institute shall--
       (1) work closely with the director of the Agency for 
     Healthcare Research and Quality to ensure that issues related 
     to workplace conditions are reflected in the activities 
     conducted by such agency in order to reduce the incidence of 
     medical errors and improve patient safety and quality of 
     care, including--
       (A) the establishment of national goals;
       (B) the development and implementation of a research 
     agenda;
       (C) the development and promotion of best practices;
       (D) the development of performance and staffing standards 
     in consultation with the Health Care Financing Administration 
     and other Federal agencies, as appropriate; and
       (E) the development and dissemination of information, 
     educational and training materials, and other criteria as it 
     relates to the delivery of quality care;
       (2) provide recommendations to the Secretary of Health and 
     Human Services and other Federal agencies with responsibility 
     for health care quality and the development of standards that 
     impact on the delivery of quality patient care on standards 
     related to workplace conditions and patient safety;
       (3) support the activities of the Health Care Financing 
     Administration related to the development of new or revised 
     conditions of participation under the medicare and medicaid 
     programs and subsequent rulemaking on issues related to 
     workplace conditions, medical errors, and patient safety and 
     quality of care; and
       (4) conduct other activities determined appropriate by the 
     director of the Institute.
       (d) Workplace Conditions.--For purposes of this section, 
     the term ``workplace conditions'' shall include issues 
     related to--
       (1) health care worker staffing;
       (2) hours of work;
       (3) confidentiality and whistleblower protections;
       (4) employee participation in decisionmaking roles that 
     contribute to improved quality of care and the reduction of 
     the incidence of medical errors;
       (5) workforce training; and
       (6) the impact of health care delivery restructuring on 
     communities and health care workers.
       (e) Definition of Health Care Worker.--
       (1) In general.--In this section, the term ``health care 
     worker'' means an individual employed by an employer that 
     provides--
       (A) health care services; or
       (B) necessary related services, including administrative, 
     food service, janitorial, or maintenance service to an entity 
     that provides such health care services.
       (2) Health care services.--In paragraph (1), the term 
     ``health care services'' includes medical, surgical, mental 
     health, and substance abuse services, whether provided on an 
     in-patient or outpatient basis.
       (f) Authorization of Appropriations.--There are authorized 
     to be appropriated to the Institute such sums as may be 
     necessary to carry out the purposes of this section.

     SEC. 402. HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE 
                   STANDARDS ADVISORY COMMITTEE.

       (a) Establishment of Committee.--There is established a 
     Health Care Quality, Patient Safety, and Workforce Standards 
     Committee (in this section referred to as the ``Committee'').
       (b) Functions of Committee.--
       (1) Advice to institute.--The Committee shall provide 
     advice to the Director of the Health Care Quality, Patient 
     Safety, and Workforce Standards Institute established under 
     section 401 on issues related to the duties of the Director.
       (2) Initial report.--Not later than December 31, 2001, the 
     Committee shall submit an initial report to the Secretary 
     that contains--
       (A) recommendations regarding minimal workforce standards 
     that are critical for improved health care quality and 
     patient safety; and
       (B) recommendations regarding additional ways to reduce the 
     incidence of medical errors and to improve patient safety and 
     quality of care.
       (3) Final report.--Not later than December 31, 2002, the 
     Committee shall submit a final report to the Secretary of 
     Health and Human Services regarding the recommendations 
     contained in the initial report required under paragraph (2), 
     including any modifications of such recommendations.
       (c) Structure and Membership of the Committee.--
       (1) Structure.--The Committee shall be composed of the 
     Director of the Health Care Quality, Patient Safety, and 
     Workforce Standards Institute established under section 401 
     and 15 additional members who shall be appointed by the 
     Secretary of Health and Human Services.
       (2) Membership.--
       (A) In general.--The members of the Committee shall be 
     chosen on the basis of their integrity, impartiality, and 
     good judgment, and shall be individuals who are, by reason of 
     their education, experience, and attainments, exceptionally 
     qualified to perform the duties of members of the Committee.
       (B) Specific members.--In making appointments under 
     paragraph (1), the Secretary of Health and Human Services 
     shall ensure that the following groups are represented:
       (i) Health care providers and health care workers, 
     including labor unions representing health care workers.
       (ii) Consumer organizations.
       (iii) Health care institutions.
       (iv) Health education organizations.
       (d) Chairman.--The Director of the Health Care Quality, 
     Patient Safety, and Workforce Standards Institute established 
     under section 401 shall chair the Committee.

                  TITLE V--IMPROVING MEDICARE BENEFITS

     SEC. 501. FULL MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT 
                   BENEFITS PARITY.

       Notwithstanding any provision of title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.), beginning January 1, 
     2001, each individual who is entitled to benefits under part 
     A or enrolled under part B of the medicare program, including 
     an individual enrolled in a Medicare+Choice plan offered by a 
     Medicare+Choice organization under part C of such program, 
     shall be provided full mental health and substance abuse 
     treatment parity under the medicare program established under 
     such title of such Act consistent with title XXII of the 
     Social Security Act (as added by this Act).

     SEC. 502. STUDY AND REPORT REGARDING ADDITION OF PRESCRIPTION 
                   DRUG BENEFIT.

       Not later than January 1, 2003, the Director of the 
     Institute of Medicine shall study and report to Congress and 
     the President legislative recommendations for adding a 
     comprehensive, accessible, and affordable prescription drug 
     benefit to the medicare program established under title XVIII 
     of the Social Security Act (42 U.S.C. 1395 et seq.).

[[Page S7238]]

                TITLE VI--LONG-TERM AND HOME HEALTH CARE

     SEC. 601. STUDIES AND DEMONSTRATION PROJECTS TO IDENTIFY 
                   MODEL PROGRAMS.

       The Secretary of Health of Human Services shall--
       (1) conduct studies and demonstration projects, through 
     grant, contract, or interagency agreement, that are designed 
     to identify model programs for the provision of long-term and 
     home health care services;
       (2) report regularly to Congress on the results of such 
     studies and demonstration projects; and
       (3) include in such report any recommendations for 
     legislation to expand or continue such studies and projects.

                        TITLE VII--MISCELLANEOUS

     SEC. 701. NONAPPLICATION OF ERISA.

       The provisions of section 514 of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1144) shall not apply 
     with respect to health benefits provided under a group health 
     plan (as defined in section 733(a) of that Act (29 U.S.C. 
     1191b(a))) qualified to offer such benefits under an 
     expansion phase (phase I) plan under title XXII of the Social 
     Security Act (as added by this Act) or under a universal 
     phase (phase II) plan under such title.

     SEC. 702. SENSE OF CONGRESS REGARDING OFFSETS.

       It is the sense of Congress that any sums necessary for the 
     implementation of this Act, and the amendments made by this 
     Act, should be offset by--
       (1) general revenues available as a result of an on-budget 
     surplus for a fiscal year;
       (2) direct savings in health care expenditures resulting 
     from the implementation of this Act; and
       (3) reductions in unnecessary Federal tax benefits 
     available only to individuals and large corporations that are 
     in the maximum tax brackets.
                                  ____


          GROWTH IN THE NUMBER OF UNINSURED AMERICANS: 1988-98
                   [Millions of nonelderly uninsured]
------------------------------------------------------------------------
                            Year
------------------------------------------------------------------------
1988.......................................................         33.6
1989.......................................................         34.3
1990.......................................................         35.6
1991.......................................................         36.3
1992.......................................................         38.3
1993.......................................................         39.3
1994.......................................................         39.4
1995.......................................................         40.3
1996.......................................................         41.4
1997.......................................................         43.1
1998.......................................................         43.9
1999.......................................................     \1\ 45.0
2000.......................................................     \2\ 55.0
------------------------------------------------------------------------
\1\ Approximate.
\2\ Projected.
 
Source: Employee Benefits Institute, 2000.
Data: Current Population Surveys (March) 1989-1999 Health Insurance
  Association of America (HIAA).


      MOST IMPORTANT REASONS FOR NOT HAVING HEALTH INSURANCE, 2000
------------------------------------------------------------------------
                                                                Percent
------------------------------------------------------------------------
It is too expensive..........................................         47
Your job doesn't offer coverage..............................         15
You are between jobs or unemployed...........................         15
You can't get coverage or were refused.......................          5
You don't think you need it..................................          3
Other........................................................         15
------------------------------------------------------------------------
Source: The NewsHour with Jim Lehrer/Kaiser Family Foundation National
  Survey on the Uninsured, 2000.

                               ______