Summary
Under H.R. 676, Medicare would be extended and improved so that all individuals residing in the United States would receive high quality and affordable health care services. They would receive all medically necessary services by the physicians of their choice, with no restrictions on what providers they could visit. If implemented, the United States National Health Insurance Act would cover primary care, dental, mental health, prescription drugs, and long term care.
To begin with, it is NOT “Socialized Medicine”, far from it in fact. Also, it does not mean that our medical system will be taken over by the government and run like the post office as many of our opposition friends would mistakenly have you believe.
Basically, House Resolution (H.R.) 676, the “New Expanded Medicare” bill now in sub-committee in the House of Representatives simply creates a new and far more functional “single payer” method of paying for medical services while leaving the medical system itself completely alone and intact. This will eliminate the hundreds of complicated and redundant payment plans currently imposed on the system by private “for profit” health insurance companies and save literally BILLIONS of dollars every year by eliminating such wasteful duplication. This will allow your doctors offices and hospitals to function much more efficiently and serve your needs much more effectively as well. Just imagine what a huge benefit this will be!
Taxes: We all know that nothing of any real value is ever free, but if you think of the taxes that will be required to support national health insurance as simply a lower cost alternative to the staggering private health insurance premiums that most of us already have to pay but which will be totally eliminated under the new system, then it becomes immediately clear that this could be a really good deal after all!
* Every citizen of the US will be covered from birth to death.
* No more pre-existing conditions to be excluded from coverage.
* No more expensive deductibles or co-pays.
* All prescription medications will be covered.
* All dental and eye care will be included.
* Mental health and substance abuse care will be fully covered.(1)
* Long term and nursing home services will be included.
* You will always choose your own doctors and hospitals.
* Costs of coverage will be assessed on a sliding scale basis.
* Tremendously simplified system of medical administration
* Total portability – your coverage not tied to any job or location.
* Existing Medicare benefits for those over 65 will remain the same or be vastly improved in many cases.
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title- This Act may be cited as the `United States National Health Insurance Act (or the Expanded and 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 USNHI Program.
Sec. 212. Appropriations for existing programs for uninsured and indigent.
TITLE III--ADMINISTRATION
Sec. 301. Public administration; appointment of Director.
Sec. 302. Quality and cost 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.
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SEC. 2. DEFINITIONS AND TERMS.
In this Act:
(1) USNHI PROGRAM; PROGRAM- The terms `USNHI 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 USNHI 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 United States National Health Insurance Card in the mail, after filling out a United States National Health Insurance 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 United States National Health Insurance Card and have payment made for such benefits.
SEC. 102. BENEFITS AND PORTABILITY.
(a) In General- The health insurance benefits under this Act cover all medically necessary services, including--
(1) primary care and prevention;
(2) inpatient care;
(3) outpatient care;
(4) emergency care;
(5) prescription drugs;
(6) durable medical equipment;
(7) long term care;
(8) mental health services;
(9) the full scope of dental services (other than cosmetic dentistry);
(10) substance abuse treatment services;
(11) chiropractic services; and
(12) basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
(b) Portability- Such benefits are available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits.
(c) No Cost-sharing- No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.
SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.
(a) Requirement to Be Public or Non-profit-
(1) IN GENERAL- No institution may be a participating provider unless it is a public or not-for-profit institution.
(2) CONVERSION OF INVESTOR-OWNED PROVIDERS- Investor-owned providers of care opting to participate shall be required to convert to not-for-profit status.
(3) COMPENSATION FOR CONVERSION- The owners of such investor-owned providers shall be compensated for the actual appraised value of converted facilities used in the delivery of care.
(4) 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).
(5) REQUIREMENTS- The conversion to a not-for-profit health care system shall take place over a 15-year period, through the sale of US Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits, but may be made only for costs associated with the conversion of real property and equipment.
(b) Quality Standards-
(1) IN GENERAL- Health care delivery facilities must meet regional and 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 actually 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, including those 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;
(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 USNHI 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, 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 USNHI Program, through its regional offices, shall pay each hospital, nursing home, community or migrant health center, home care agencies, or other institutional provider or pre-paid group practice 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 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, 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, 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 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 regional differences in reimbursement, but strive for a uniform national standard.
(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 regional directors 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 whose bills are not paid within 30 days of submission.
(F) NO BALANCE BILLING- Licensed health care clinicians who accept any payment from the USNHI Program may not bill any patient for any covered service.
(G) UNIFORM COMPUTER ELECTRONIC BILLING SYSTEM- The Director shall make a good faith effort to create a uniform computerized electronic billing system, including in 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 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 premiums to cover all outpatient, physician, and medical home care provided to individuals enrolled to receive benefits through the organization or entity.
(B) SCOPE- Such capitation may include the costs of services of licensed physicians and other licensed, independent practitioners provided to inpatients. Other costs of inpatient and institutional care shall be excluded from capitation payments, and shall be covered under institutions' global budgets.
(C) PROHIBITION OF SELECTIVE ENROLLMENT- Selective enrollment policies are prohibited, and patients shall be permitted to enroll or disenroll from such organizations or entities 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 USNHI 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 when indicated for a specific patient or condition.
(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.
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