[Congressional Record Volume 163, Number 126 (Wednesday, July 26, 2017)]
[Senate]
[Pages S4322-S4325]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 340. Mr. McCONNELL (for Mr. Daines) proposed an amendment to
amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to
provide for reconciliation pursuant to title II of the concurrent
resolution on the budget for fiscal year 2017; as follows:
In lieu of the matter proposed to be inserted, insert the
following:
1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Expanded &
Improved Medicare For All Act''.
(b) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions and terms.
TITLE I--ELIGIBILITY AND BENEFITS
Sec. 101. Eligibility and registration.
Sec. 102. Benefits and portability.
Sec. 103. Qualification of participating providers.
Sec. 104. Prohibition against duplicating coverage.
TITLE II--FINANCES
Subtitle A--Budgeting and Payments
Sec. 201. Budgeting process.
Sec. 202. Payment of providers and health care clinicians.
Sec. 203. Payment for long-term care.
Sec. 204. Mental health services.
Sec. 205. Payment for prescription medications, medical supplies, and
medically necessary assistive equipment.
Sec. 206. Consultation in establishing reimbursement levels.
Subtitle B--Funding
Sec. 211. Overview: funding the Medicare For All Program.
Sec. 212. Appropriations for existing programs.
TITLE III--ADMINISTRATION
Sec. 301. Public administration; appointment of Director.
Sec. 302. Office of Quality Control.
Sec. 303. Regional and State administration; employment of displaced
clerical workers.
Sec. 304. Confidential electronic patient record system.
Sec. 305. National Board of Universal Quality and Access.
TITLE IV--ADDITIONAL PROVISIONS
Sec. 401. Treatment of VA and IHS health programs.
Sec. 402. Public health and prevention.
Sec. 403. Reduction in health disparities.
TITLE V--EFFECTIVE DATE
Sec. 501. Effective date.
SEC. 2. DEFINITIONS AND TERMS.
In this Act:
(1) Medicare for all program; program.--The terms
``Medicare For All Program'' and ``Program'' mean the program
of benefits provided under this Act and, unless the context
otherwise requires, the Secretary with respect to functions
relating to carrying out such program.
(2) National board of universal quality and access.--The
term ``National Board of Universal Quality and Access'' means
such Board established under section 305.
(3) Regional office.--The term ``regional office'' means a
regional office established under section 303.
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(5) Director.--The term ``Director'' means, in relation to
the Program, the Director appointed under section 301.
TITLE I--ELIGIBILITY AND BENEFITS
SEC. 101. ELIGIBILITY AND REGISTRATION.
(a) In General.--All individuals residing in the United
States (including any territory of the United States) are
covered under the Medicare For All Program entitling them to
a universal, best quality standard of care. Each such
individual shall receive a card with a unique number in the
mail. An individual's Social Security number shall not be
used for purposes of registration under this section.
(b) Registration.--Individuals and families shall receive a
Medicare For All Program Card in the mail, after filling out
a Medicare For All Program application form at a health care
provider. Such application form shall be no more than 2 pages
long.
(c) Presumption.--Individuals who present themselves for
covered services from a participating provider shall be
presumed to be eligible for benefits under this Act, but
shall complete an application for benefits in order to
receive a Medicare For All Program Card and have payment made
for such benefits.
(d) Residency Criteria.--The Secretary shall promulgate a
rule that provides criteria for determining residency for
eligibility purposes under the Medicare For All Program.
(e) Coverage for Visitors.--The Secretary shall promulgate
a rule regarding visitors from other countries who seek
premeditated non-emergency surgical procedures. Such a rule
should facilitate the establishment of country-to-country
reimbursement arrangements or self pay arrangements between
the visitor and the provider of care.
SEC. 102. BENEFITS AND PORTABILITY.
(a) In General.--The health care benefits under this Act
cover all medically necessary services, including at least
the following:
(1) Primary care and prevention.
(2) Approved dietary and nutritional therapies.
(3) Inpatient care.
(4) Outpatient care.
(5) Emergency care.
(6) Prescription drugs.
(7) Durable medical equipment.
(8) Long-term care.
(9) Palliative care.
(10) Mental health services.
(11) The full scope of dental services, services, including
periodontics, oral surgery, and endodontics, but not
including cosmetic dentistry.
(12) Substance abuse treatment services.
(13) Chiropractic services, not including electrical
stimulation.
(14) Basic vision care and vision correction (other than
laser vision correction for cosmetic purposes).
(15) Hearing services, including coverage of hearing aids.
(16) Podiatric care.
(b) Portability.--Such benefits are available through any
licensed health care clinician anywhere in the United States
that is legally qualified to provide the benefits.
[[Page S4323]]
(c) No Cost-Sharing.--No deductibles, copayments,
coinsurance, or other cost-sharing shall be imposed with
respect to covered benefits.
SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.
(a) Requirement To Be Public or Non-Profit.--
(1) In general.--No institution may be a participating
provider unless it is a public or not-for-profit institution.
Private physicians, private clinics, and private health care
providers shall continue to operate as private entities, but
are prohibited from being investor owned.
(2) Conversion of investor-owned providers.--For-profit
providers of care opting to participate shall be required to
convert to not-for-profit status.
(3) Private delivery of care requirement.--For-profit
providers of care that convert to non-profit status shall
remain privately owned and operated entities.
(4) Compensation for conversion.--The owners of such for-
profit providers shall be compensated for reasonable
financial losses incurred as a result of the conversion from
for-profit to non-profit status.
(5) Funding.--There are authorized to be appropriated from
the Treasury such sums as are necessary to compensate
investor-owned providers as provided for under paragraph (3).
(6) Requirements.--The payments to owners of converting
for-profit providers shall occur during a 15-year period,
through the sale of U.S. Treasury Bonds. Payment for
conversions under paragraph (3) shall not be made for loss of
business profits.
(7) Mechanism for conversion process.--The Secretary shall
promulgate a rule to provide a mechanism to further the
timely, efficient, and feasible conversion of for-profit
providers of care.
(b) Quality Standards.--
(1) In general.--Health care delivery facilities must meet
State quality and licensing guidelines as a condition of
participation under such program, including guidelines
regarding safe staffing and quality of care.
(2) Licensure requirements.--Participating clinicians must
be licensed in their State of practice and meet the quality
standards for their area of care. No clinician whose license
is under suspension or who is under disciplinary action in
any State may be a participating provider.
(c) Participation of Health Maintenance Organizations.--
(1) In general.--Non-profit health maintenance
organizations that deliver care in their own facilities and
employ clinicians on a salaried basis may participate in the
program and receive global budgets or capitation payments as
specified in section 202.
(2) Exclusion of certain health maintenance
organizations.--Other health maintenance organizations which
principally contract to pay for services delivered by non-
employees shall be classified as insurance plans. Such
organizations shall not be participating providers, and are
subject to the regulations promulgated by reason of section
104(a) (relating to prohibition against duplicating
coverage).
(d) Freedom of Choice.--Patients shall have free choice of
participating physicians and other clinicians, hospitals, and
inpatient care facilities.
SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE.
(a) In General.--It is unlawful for a private health
insurer to sell health insurance coverage that duplicates the
benefits provided under this Act.
(b) Construction.--Nothing in this Act shall be construed
as prohibiting the sale of health insurance coverage for any
additional benefits not covered by this Act, such as for
cosmetic surgery or other services and items that are not
medically necessary.
TITLE II--FINANCES
Subtitle A--Budgeting and Payments
SEC. 201. BUDGETING PROCESS.
(a) Establishment of Operating Budget and Capital
Expenditures Budget.--
(1) In general.--To carry out this Act there are
established on an annual basis consistent with this title--
(A) an operating budget, including amounts for optimal
physician, nurse, and other health care professional
staffing;
(B) a capital expenditures budget;
(C) reimbursement levels for providers consistent with
subtitle B; and
(D) a health professional education budget, including
amounts for the continued funding of resident physician
training programs.
(2) Regional allocation.--After Congress appropriates
amounts for the annual budget for the Medicare For All
Program, the Director shall provide the regional offices with
an annual funding allotment to cover the costs of each
region's expenditures. Such allotment shall cover global
budgets, reimbursements to clinicians, health professional
education, and capital expenditures. Regional offices may
receive additional funds from the national program at the
discretion of the Director.
(b) Operating Budget.--The operating budget shall be used
for--
(1) payment for services rendered by physicians and other
clinicians;
(2) global budgets for institutional providers;
(3) capitation payments for capitated groups; and
(4) administration of the Program.
(c) Capital Expenditures Budget.--The capital expenditures
budget shall be used for funds needed for--
(1) the construction or renovation of health facilities;
and
(2) for major equipment purchases.
(d) Prohibition Against Co-Mingling Operations and Capital
Improvement Funds.--It is prohibited to use funds under this
Act that are earmarked--
(1) for operations for capital expenditures; or
(2) for capital expenditures for operations.
SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLINICIANS.
(a) Establishing Global Budgets; Monthly Lump Sum.--
(1) In general.--The Medicare For All Program, through its
regional offices, shall pay each institutional provider of
care, including hospitals, nursing homes, community or
migrant health centers, home care agencies, or other
institutional providers or pre-paid group practices, a
monthly lump sum to cover all operating expenses under a
global budget.
(2) Establishment of global budgets.--The global budget of
a provider shall be set through negotiations between
providers, State directors, and regional directors, but are
subject to the approval of the Director. The budget shall be
negotiated annually, based on past expenditures, projected
changes in levels of services, wages and input, costs, a
provider's maximum capacity to provide care, and proposed new
and innovative programs.
(b) Three Payment Options for Physicians and Certain Other
Health Professionals.--
(1) In general.--The Program shall pay physicians,
dentists, doctors of osteopathy, pharmacists, psychologists,
chiropractors, doctors of optometry, nurse practitioners,
nurse midwives, physicians' assistants, and other advanced
practice clinicians as licensed and regulated by the States
by the following payment methods:
(A) Fee for service payment under paragraph (2).
(B) Salaried positions in institutions receiving global
budgets under paragraph (3).
(C) Salaried positions within group practices or non-profit
health maintenance organizations receiving capitation
payments under paragraph (4).
(2) Fee for service.--
(A) In general.--The Program shall negotiate a simplified
fee schedule that is fair and optimal with representatives of
physicians and other clinicians, after close consultation
with the National Board of Universal Quality and Access and
regional and State directors. Initially, the current
prevailing fees or reimbursement would be the basis for the
fee negotiation for all professional services covered under
this Act.
(B) Considerations.--In establishing such schedule, the
Director shall take into consideration the following:
(i) The need for a uniform national standard.
(ii) The goal of ensuring that physicians, clinicians,
pharmacists, and other medical professionals be compensated
at a rate which reflects their expertise and the value of
their services, regardless of geographic region and past fee
schedules.
(C) State physician practice review boards.--The State
director for each State, in consultation with representatives
of the physician community of that State, shall establish and
appoint a physician practice review board to assure quality,
cost effectiveness, and fair reimbursements for physician
delivered services.
(D) Final guidelines.--The Director shall be responsible
for promulgating final guidelines to all providers.
(E) Billing.--Under this Act physicians shall submit bills
to the regional director on a simple form, or via computer.
Interest shall be paid to providers who are not reimbursed
within 30 days of submission.
(F) No balance billing.--Licensed health care clinicians
who accept any payment from the Medicare For All Program may
not bill any patient for any covered service.
(G) Uniform computer electronic billing system.--The
Director shall create a uniform computerized electronic
billing system, including those areas of the United States
where electronic billing is not yet established.
(3) Salaries within institutions receiving global
budgets.--
(A) In general.--In the case of an institution, such as a
hospital, health center, group practice, community and
migrant health center, or a home care agency that elects to
be paid a monthly global budget for the delivery of health
care as well as for education and prevention programs,
physicians and other clinicians employed by such institutions
shall be reimbursed through a salary included as part of such
a budget.
(B) Salary ranges.--Salary ranges for health care providers
shall be determined in the same way as fee schedules under
paragraph (2).
(4) Salaries within capitated groups.--
(A) In general.--Health maintenance organizations, group
practices, and other institutions may elect to be paid
capitation payments to cover all outpatient, physician, and
medical home care provided to individuals enrolled to receive
benefits through the organization or entity.
(B) Scope.--Such capitation may include the costs of
services of licensed physicians and other licensed,
independent practitioners provided to inpatients. Other costs
of
[[Page S4324]]
inpatient and institutional care shall be excluded from
capitation payments, and shall be covered under institutions'
global budgets.
(C) Prohibition of selective enrollment.--Patients shall be
permitted to enroll or disenroll from such organizations or
entities without discrimination and with appropriate notice.
(D) Health maintenance organizations.--Under this Act--
(i) health maintenance organizations shall be required to
reimburse physicians based on a salary; and
(ii) financial incentives between such organizations and
physicians based on utilization are prohibited.
SEC. 203. PAYMENT FOR LONG-TERM CARE.
(a) Allotment for Regions.--The Program shall provide for
each region a single budgetary allotment to cover a full
array of long-term care services under this Act.
(b) Regional Budgets.--Each region shall provide a global
budget to local long-term care providers for the full range
of needed services, including in-home, nursing home, and
community based care.
(c) Basis for Budgets.--Budgets for long-term care services
under this section shall be based on past expenditures,
financial and clinical performance, utilization, and
projected changes in service, wages, and other related
factors.
(d) Favoring Non-Institutional Care.--All efforts shall be
made under this Act to provide long-term care in a home- or
community-based setting, as opposed to institutional care.
SEC. 204. MENTAL HEALTH SERVICES.
(a) In General.--The Program shall provide coverage for all
medically necessary mental health care on the same basis as
the coverage for other conditions. Licensed mental health
clinicians shall be paid in the same manner as specified for
other health professionals, as provided for in section
202(b).
(b) Favoring Community-Based Care.--The Medicare For All
Program shall cover supportive residences, occupational
therapy, and ongoing mental health and counseling services
outside the hospital for patients with serious mental
illness. In all cases the highest quality and most effective
care shall be delivered, and, for some individuals, this may
mean institutional care.
SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, MEDICAL
SUPPLIES, AND MEDICALLY NECESSARY ASSISTIVE
EQUIPMENT.
(a) Negotiated Prices.--The prices to be paid each year
under this Act for covered pharmaceuticals, medical supplies,
and medically necessary assistive equipment shall be
negotiated annually by the Program.
(b) Prescription Drug Formulary.--
(1) In general.--The Program shall establish a prescription
drug formulary system, which shall encourage best-practices
in prescribing and discourage the use of ineffective,
dangerous, or excessively costly medications when better
alternatives are available.
(2) Promotion of use of generics.--The formulary shall
promote the use of generic medications but allow the use of
brand-name and off-formulary medications.
(3) Formulary updates and petition rights.--The formulary
shall be updated frequently and clinicians and patients may
petition their region or the Director to add new
pharmaceuticals or to remove ineffective or dangerous
medications from the formulary.
SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSEMENT LEVELS.
Reimbursement levels under this subtitle shall be set after
close consultation with regional and State Directors and
after the annual meeting of National Board of Universal
Quality and Access.
Subtitle B--Funding
SEC. 211. OVERVIEW: FUNDING THE MEDICARE FOR ALL PROGRAM.
(a) In General.--The Medicare For All Program is to be
funded as provided in subsection (c)(1).
(b) Medicare For All Trust Fund.--There shall be
established a Medicare For All Trust Fund in which funds
provided under this section are deposited and from which
expenditures under this Act are made.
(c) Funding.--
(1) In general.--There are appropriated to the Medicare For
All Trust Fund amounts sufficient to carry out this Act from
the following sources:
(A) Existing sources of Federal Government revenues for
health care.
(B) Increasing personal income taxes on the top 5 percent
income earners.
(C) Instituting a modest and progressive excise tax on
payroll and self-employment income.
(D) Instituting a modest tax on unearned income.
(E) Instituting a small tax on stock and bond transactions.
(2) System savings as a source of financing.--Funding
otherwise required for the Program is reduced as a result
of--
(A) vastly reducing paperwork;
(B) requiring a rational bulk procurement of medications
under section 205(a); and
(C) improved access to preventive health care.
(3) Additional annual appropriations to medicare for all
program.--Additional sums are authorized to be appropriated
annually as needed to maintain maximum quality, efficiency,
and access under the Program.
SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS.
Notwithstanding any other provision of law, there are
hereby transferred and appropriated to carry out this Act,
amounts from the Treasury equivalent to the amounts the
Secretary estimates would have been appropriated and expended
for Federal public health care programs, including funds that
would have been appropriated under the Medicare program under
title XVIII of the Social Security Act, under the Medicaid
program under title XIX of such Act, and under the Children's
Health Insurance Program under title XXI of such Act.
TITLE III--ADMINISTRATION
SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DIRECTOR.
(a) In General.--Except as otherwise specifically provided,
this Act shall be administered by the Secretary through a
Director appointed by the Secretary.
(b) Long-Term Care.--The Director shall appoint a director
for long-term care who shall be responsible for
administration of this Act and ensuring the availability and
accessibility of high quality long-term care services.
(c) Mental Health.--The Director shall appoint a director
for mental health who shall be responsible for administration
of this Act and ensuring the availability and accessibility
of high quality mental health services.
SEC. 302. OFFICE OF QUALITY CONTROL.
The Director shall appoint a director for an Office of
Quality Control. Such director shall, after consultation with
State and regional directors, provide annual recommendations
to Congress, the President, the Secretary, and other Program
officials on how to ensure the highest quality health care
service delivery. The director of the Office of Quality
Control shall conduct an annual review on the adequacy of
medically necessary services, and shall make recommendations
of any proposed changes to the Congress, the President, the
Secretary, and other Medicare For All Program officials.
SEC. 303. REGIONAL AND STATE ADMINISTRATION; EMPLOYMENT OF
DISPLACED CLERICAL WORKERS.
(a) Establishment of Medicare For All Program Regional
Offices.--The Secretary shall establish and maintain Medicare
For All regional offices for the purpose of distributing
funds to providers of care. Whenever possible, the Secretary
should incorporate pre-existing Medicare infrastructure for
this purpose.
(b) Appointment of Regional and State Directors.--In each
such regional office there shall be--
(1) one regional director appointed by the Director; and
(2) for each State in the region, a deputy director (in
this Act referred to as a ``State Director'') appointed by
the governor of that State.
(c) Regional Office Duties.--Regional offices of the
Program shall be responsible for--
(1) coordinating funding to health care providers and
physicians; and
(2) coordinating billing and reimbursements with physicians
and health care providers through a State-based reimbursement
system.
(d) State Director's Duties.--Each State Director shall be
responsible for the following duties:
(1) Providing an annual State health care needs assessment
report to the National Board of Universal Quality and Access,
and the regional board, after a thorough examination of
health needs, in consultation with public health officials,
clinicians, patients, and patient advocates.
(2) Health planning, including oversight of the placement
of new hospitals, clinics, and other health care delivery
facilities.
(3) Health planning, including oversight of the purchase
and placement of new health equipment to ensure timely access
to care and to avoid duplication.
(4) Submitting global budgets to the regional director.
(5) Recommending changes in provider reimbursement or
payment for delivery of health services in the State.
(6) Establishing a quality assurance mechanism in the State
in order to minimize both under utilization and over
utilization and to assure that all providers meet high
quality standards.
(7) Reviewing program disbursements on a quarterly basis
and recommending needed adjustments in fee schedules needed
to achieve budgetary targets and assure adequate access to
needed care.
(e) First Priority in Retraining and Job Placement; 2 Years
of Salary Parity Benefits.--The Program shall provide that
clerical, administrative, and billing personnel in insurance
companies, doctors offices, hospitals, nursing facilities,
and other facilities whose jobs are eliminated due to reduced
administration--
(1) should have first priority in retraining and job
placement in the new system; and
(2) shall be eligible to receive two years of Medicare For
All employment transition benefits with each year's benefit
equal to salary earned during the last 12 months of
employment, but shall not exceed $100,000 per year.
(f) Establishment of Medicare For All Employment Transition
Fund.--The Secretary shall establish a trust fund from
[[Page S4325]]
which expenditures shall be made to recipients of the
benefits allocated in subsection (e).
(g) Annual Appropriations to Medicare For All Employment
Transition Fund.--Sums are authorized to be appropriated
annually as needed to fund the Medicare For All Employment
Transition Benefits.
(h) Retention of Right to Unemployment Benefits.--Nothing
in this section shall be interpreted as a waiver of Medicare
For All Employment Transition benefit recipients' right to
receive Federal and State unemployment benefits.
SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD SYSTEM.
(a) In General.--The Secretary shall create a standardized,
confidential electronic patient record system in accordance
with laws and regulations to maintain accurate patient
records and to simplify the billing process, thereby reducing
medical errors and bureaucracy.
(b) Patient Option.--Notwithstanding that all billing shall
be preformed electronically, patients shall have the option
of keeping any portion of their medical records separate from
their electronic medical record.
SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND ACCESS.
(a) Establishment.--
(1) In general.--There is established a National Board of
Universal Quality and Access (in this section referred to as
the ``Board'') consisting of 15 members appointed by the
President, by and with the advice and consent of the Senate.
(2) Qualifications.--The appointed members of the Board
shall include at least one of each of the following:
(A) Health care professionals.
(B) Representatives of institutional providers of health
care.
(C) Representatives of health care advocacy groups.
(D) Representatives of labor unions.
(E) Citizen patient advocates.
(3) Terms.--Each member shall be appointed for a term of 6
years, except that the President shall stagger the terms of
members initially appointed so that the term of no more than
3 members expires in any year.
(4) Prohibition on conflicts of interest.--No member of the
Board shall have a financial conflict of interest with the
duties before the Board.
(b) Duties.--
(1) In general.--The Board shall meet at least twice per
year and shall advise the Secretary and the Director on a
regular basis to ensure quality, access, and affordability.
(2) Specific issues.--The Board shall specifically address
the following issues:
(A) Access to care.
(B) Quality improvement.
(C) Efficiency of administration.
(D) Adequacy of budget and funding.
(E) Appropriateness of reimbursement levels of physicians
and other providers.
(F) Capital expenditure needs.
(G) Long-term care.
(H) Mental health and substance abuse services.
(I) Staffing levels and working conditions in health care
delivery facilities.
(3) Establishment of universal, best quality standard of
care.--The Board shall specifically establish a universal,
best quality of standard of care with respect to--
(A) appropriate staffing levels;
(B) appropriate medical technology;
(C) design and scope of work in the health workplace;
(D) best practices; and
(E) salary level and working conditions of physicians,
clinicians, nurses, other medical professionals, and
appropriate support staff.
(4) Twice-a-year report.--The Board shall report its
recommendations twice each year to the Secretary, the
Director, Congress, and the President.
(c) Compensation, etc.--The following provisions of section
1805 of the Social Security Act shall apply to the Board in
the same manner as they apply to the Medicare Payment
Assessment Commission (except that any reference to the
Commission or the Comptroller General shall be treated as
references to the Board and the Secretary, respectively):
(1) Subsection (c)(4) (relating to compensation of Board
members).
(2) Subsection (c)(5) (relating to chairman and vice
chairman).
(3) Subsection (c)(6) (relating to meetings).
(4) Subsection (d) (relating to director and staff; experts
and consultants).
(5) Subsection (e) (relating to powers).
TITLE IV--ADDITIONAL PROVISIONS
SEC. 401. TREATMENT OF VA AND IHS HEALTH PROGRAMS.
(a) VA Health Programs.--This Act provides for health
programs of the Department of Veterans' Affairs to initially
remain independent for the 10-year period that begins on the
date of the establishment of the Medicare For All Program.
After such 10-year period, the Congress shall reevaluate
whether such programs shall remain independent or be
integrated into the Medicare For All Program.
(b) Indian Health Service Programs.--This Act provides for
health programs of the Indian Health Service to initially
remain independent for the 5-year period that begins on the
date of the establishment of the Medicare For All Program,
after which such programs shall be integrated into the
Medicare For All Program.
SEC. 402. PUBLIC HEALTH AND PREVENTION.
It is the intent of this Act that the Program at all times
stress the importance of good public health through the
prevention of diseases.
SEC. 403. REDUCTION IN HEALTH DISPARITIES.
It is the intent of this Act to reduce health disparities
by race, ethnicity, income and geographic region, and to
provide high quality, cost-effective, culturally appropriate
care to all individuals regardless of race, ethnicity, sexual
orientation, or language.
TITLE V--EFFECTIVE DATE
SEC. 501. EFFECTIVE DATE.
Except as otherwise specifically provided, this Act shall
take effect on the first day of the first year that begins
more than 1 year after the date of the enactment of this Act,
and shall apply to items and services furnished on or after
such date.
______