[Congressional Record Volume 161, Number 120 (Tuesday, July 28, 2015)]
[Extensions of Remarks]
[Page E1147]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           THE STATE-BASED UNIVERSAL HEALTH CARE ACT OF 2015

                                 ______
                                 

                           HON. JIM McDERMOTT

                             of washington

                    in the house of representatives

                         Tuesday, July 28, 2015

  Mr. McDERMOTT. Mr. Speaker, I rise today to introduce legislation 
that will give states the tools they need to guarantee the health 
security of their citizens. The State-Based Universal Health Care Act 
of 2015 establishes a new procedure through which states may apply for 
a waiver of federal law in order to design and implement single-payer 
health care systems. This will allow states to achieve universal 
coverage and control costs by removing greed and inefficiency from the 
system.
  One of the many achievements of the Affordable Care Act is its 
provisions that grant states the authority to innovate in their health 
care systems. Under Section 1332 of the law, a state may apply for a 
State Innovation Waiver that will provide it with control of federal 
dollars that otherwise would have been spent on premium tax credits and 
cost-sharing reductions for its residents. Through this waiver, a state 
may design a system to cover its residents, so long as benefits are at 
least as comprehensive and affordable as those offered by Qualified 
Health Plans available on the Exchanges.
  However, even with this flexibility, numerous barriers limit states' 
ability to design true single-payer systems. Existing waivers are 
narrow in scope, requiring states to seek out imperfect and convoluted 
solutions to circumvent federal limitations. A sweeping preemption 
provision in the Employee Retirement Income Security Act (ERISA) denies 
states authority to regulate employer-sponsored health plans. And, due 
to the complexities of our existing federal health programs, it is 
essentially impossible for a state to design a single benefit package 
that can be administered simply and efficiently on behalf of all of its 
residents.
  The State-Based Universal Health Care Act removes these barriers. It 
builds upon the ACA's State Innovation Waiver by offering states new 
tools that will allow them to truly innovate in health care. Under this 
legislation, a state may apply for a Universal Health Care Waiver that 
will grant it authority over federal health care dollars that otherwise 
would have been spent on the state's residents. To the extent necessary 
to design a universal system, a state may waive provisions of federal 
law relating to the following:
  The rules governing premium tax credits and cost-sharing reductions, 
as provided for in existing waiver authority under Section 1332 of the 
ACA.
  Provisions necessary for states to pool funds that otherwise would be 
spent on behalf of residents enrolled in Medicare, Medicaid, CHIP, 
TRICARE, and the Federal Employee Health Benefits Program.
  ERISA's preemption clause, which currently forbids states from 
enacting legislation relating to employee health benefit programs.
  Any state seeking a Universal Health Care Waiver must design a system 
that covers substantially all of its residents. The benefits that each 
citizen receives must be at least as comprehensive and no less 
affordable than what would have been provided under any federal health 
programs for which its residents otherwise would have been eligible. 
Once enacted, the state plan must be publicly administered, and it may 
not add to the federal deficit.
  The Affordable Care Act was a landmark achievement and a strong first 
step toward achieving health security in this country. However, we 
still have a tremendous amount of work left to do. The United States 
spends by far the most per capita on health care, yet we fail to 
achieve superior outcomes or even guarantee coverage as a basic human 
right. Insurance companies are a powerful force in our economy, 
enjoying billions in profits and growing power in the marketplace. 
Meanwhile, hospitals are consolidating at an astonishing rate, raising 
new questions about the quality of patient care and the future of 
medicine. What's more, we have failed to make meaningful efforts to 
combat the skyrocketing costs of prescription drugs, threatening 
patient access to treatments and the financial sustainability of the 
entire system.
  As we explore ways to build upon the successes of the ACA, it is 
critical that we look for creative solutions to the challenges that 
still exist. Granting states tools to design single-payer systems will 
help spur necessary innovation, achieve universal coverage, and control 
costs. It is time to take this next step as we continue to move forward 
in our historic effort to guarantee the health security of every 
American.

                          ____________________