I 

108TH CONGRESS 

1ST SESSION H. R. 3000

To establish a United States Health Service to provide high quality comprehensive health care for all Americans and to overcome the deficiencies 

in the present system of health care delivery. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 4, 2003

Ms. LEE (for herself, Mrs. CHRISTENSEN, Mr. KUCINICH, Mr. CUMMINGS, 

Mr. DAVIS of Illinois, Mr. OWENS, Mr. JACKSON of Illinois, Ms. WOOLSEY, Mr. PAYNE, Mr. CONYERS, and Ms. CARSON of Indiana) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce, and in addition to the Committees on Education and the 

Workforce and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

A BILL

To establish a United States Health Service to provide high 

quality comprehensive health care for all Americans and 

to overcome the deficiencies in the present system of 

health care delivery.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Josephine Butler United States Health Service Act’’. 
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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows:

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

Sec. 3. Purposes. 

Sec. 4. Definitions. 

TITLE I—ESTABLISHMENT AND OPERATION OF THE UNITED 

STATES HEALTH SERVICE 

Sec. 101. Establishment of the Service. 

Sec. 102. Appointment of the National Health Board. 

Sec. 103. Powers and duties of the National Health Board. 

Sec. 104. Representation in local and regional authorities. 

Sec. 105. Public accountability and financial disclosure. 

Sec. 106. Inspector General. 

Sec. 107. Establishment of health care delivery regions. 

TITLE II—DELIVERY OF HEALTH CARE AND SUPPLEMENTAL 

SERVICES 

Subtitle A—Patients’ Rights in Health Care Delivery 

Sec. 201. Basic health rights. 

Sec. 202. Right to paid leave to receive health care services. 

Subtitle B—Eligibility for, Nature of, and Scope of Services Provided by the 

Service 

Sec. 211. Eligibility for services. 

Sec. 212. Entitlement to services. 

Sec. 213. Provision of health care and supplemental services. 

Subtitle C—Health Care Facilities and Delivery of Health Care Services 

Sec. 221. Establishment of health care facilities and distribution of delivery of 

health care and other services. 

Sec. 222. Operation and inspection of health care facilities. 

Sec. 223. Provision of health services relating to reproduction and childbearing. 

TITLE III—HEALTH LABOR FORCE 

Subtitle A—Job Categories and Certification 

Sec. 301. Effect of State law. 

Sec. 302. Qualifications of health workers. 

Sec. 303. Establishment of job categories and certification standards. 

Subtitle B—Education of Health Workers 

Sec. 311. Health team schools. 

Sec. 312. Service requirement. 

Sec. 313. Payment for certain educational loans. 

Subtitle C—Employment and Labor-Management Relations Within the Service 
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Sec. 321. Employment, transfer, promotion, and receipt of fees. 

Sec. 322. Applicability of laws relating to Federal employees. 

Sec. 323. Applicability of Federal labor-management relations laws. 

Sec. 324. Defense of certain malpractice and negligence suits. 

TITLE IV—OTHER FUNCTIONS OF HEALTH BOARDS 

Subtitle A—Advocacy, Grievance Procedures, and Trusteeships 

Sec. 401. Advocacy and legal services program. 

Sec. 402. Grievance procedures. 

Subtitle B—Occupational Safety and Health Programs 

Sec. 411. Functions of the National Health Board. 

Sec. 412. Community occupational safety and health activities. 

Sec. 413. Workplace health facilities. 

Sec. 414. Employee rights relating to occupational safety and health. 

Sec. 415. Definitions. 

Subtitle C—Health and Health Care Delivery Research, Quality Assurance, 

and Health Equity 

Sec. 421. Principles and guidelines for research. 

Sec. 422. Establishment of institutes. 

Subtitle D—Health Planning, Distribution of Drugs and Other Medical 

Supplies, and Miscellaneous Functions 

Sec. 431. Health planning and budgeting. 

Sec. 432. Distribution of drugs and other medical supplies. 

Sec. 433. Miscellaneous functions of the National Health Board. 

TITLE V—FINANCING OF THE SERVICE 

Subtitle A—Health Service Taxes 

Sec. 501. Individual and corporate income taxes. 

Sec. 502. Other changes in the Internal Revenue Code of 1986. 

Sec. 503. Existing employer-employee health benefit plans. 

Sec. 504. Workers compensation programs. 

Subtitle B—Health Service Trust Fund 

Sec. 511. Establishment of health service trust fund. 

Sec. 512. Transfer of funds to the health service trust fund. 

Sec. 513. Administration of health service trust fund. 

Subtitle C—Preparation of Plans and Budgets 

Sec. 521. Determination of fund availability. 

Sec. 522. Preparation of regional budgets. 

Subtitle D—Allocation and Distribution of Funds 

Sec. 531. National budget. 

Sec. 532. Special operating expense fund. 

Sec. 533. Distribution of funds. 

Sec. 534. Annual statement, records, and audits. 
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Subtitle E—General Provisions 

Sec. 541. Issuance of obligations. 

Sec. 542. Definitions. 

TITLE VI—MISCELLANEOUS PROVISIONS 

Sec. 601. Effective date of health services. 

Sec. 602. Repeal of provisions. 

Sec. 603. Transition provisions. 

Sec. 604. Amendment to Budget and Accounting Act. 

Sec. 605. Separability.

1 SEC. 2. FINDINGS. 

2 The Congress makes the following findings: 

3 (1) The health of the Nation’s people is a foun4 dation of their well-being. 

5 (2) High quality health care is a right of all 

6 people.

7 (3) Many of the Nation’s people are unable 

8 fully to exercise this right because of the inability of 

9 the present health care delivery system to make high 

10 quality health care available to all individuals re11 gardless of race, sex, age, national origin, income, 

12 marital status, sexual orientation, religion, political 

13 belief, place of residence, employment status, or pre14 vious health status. 

15 (4) The present health care system has failed to 

16 provide financial coverage for health care services 

17 for more than forty million Americans, and the per18 cent lacking such coverage grows each year. 

19 (5) The present health care system has failed to 

20 provide for sufficient effective preventive measures 
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1 that would address the deterioration in occupational, 

2 environmental, and social conditions affecting the 

3 health of the people of this Nation. 

4 (6) Unnecessary and excessive profits and ad5 ministrative expenses have inflated the cost of health 

6 care. 

7 (7) The growth of for profit medical care and 

8 for profit managed care is making it difficult for 

9 health care personnel to provide, and users to re10 ceive, the full range of health services they believe to 

11 be necessary, appropriate, and desirable. 

12 (8) The health professions have failed to control 

13 the cost of their services and the imbalance in the 

14 number of health workers among geographic areas 

15 or health care specialties. 

16 (9) The present health care system has failed to 

17 make full and efficient use of allied health workers. 

18 (10) A United States Health Service is the best 

19 means to implement the right to high quality health 

20 care and to overcome the deficiencies in the present 

21 health care delivery system. 

22 SEC. 3. PURPOSES. 

23 The purposes of this Act are as follows: 

24 (1) To create a United States Health Service to 

25 provide without charge to all residents, regardless of 
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1 race, sex, age, national origin, income, marital sta2 tus, sexual orientation, religion, political belief, place 

3 of residence, employment status, or previous health 

4 status, comprehensive health care services delivered 

5 by salaried health workers and emphasizing the pro6 motion and maintenance of health as well as the 

7 treatment of illness. 

8 (2) To establish representative and democratic 

9 governance of the Service. 

10 (3) To provide health workers in the Service 

11 with fair and reasonable compensation, secure em12 ployment, opportunities for full and equal participa13 tion in the governance of health facilities, and oppor14 tunities for advancement without regard to race, sex, 

15 age, national origin, sexual orientation, religion, or 

16 political belief. 

17 (4) To increase the availability and continuity 

18 of health care by linking local health care facilities 

19 to hospitals and specialized care facilities. 

20 (5) To overcome present disparities in health 

21 and access to health care resources, especially for 

22 currently underserved innercity and rural popu23 lations, minority groups, prisoners, and occupational 

24 groups, by redistributing health care resources to 
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1 underserved populations, and by enhancing public 

2 health and preventive health services. 

3 (6) To finance the Service through progressive 

4 taxation of individuals and employer contributions, 

5 and to distribute these revenues on a capitation 

6 basis, supplemented by allocations to meet special 

7 health care needs. 

8 SEC. 4. DEFINITIONS. 

9 For the purposes of this Act, unless the context im10 plies otherwise: 

11 (1) HEALTH CARE FACILITY.—The term 

12 ‘‘health care facility’’ means an administrative unit 

13 composed of specified staff, equipment, and premises 

14 and established by a health board as an appropriate 

15 unit of organization for the delivery of specified 

16 health care or supplemental services under this Act. 

17 (2) HEALTH WORKER.—The term ‘‘health 

18 worker’’ includes—

19 (A) any employee of the Service; and 

20 (B) any individual who for remuneration 

21 delivers, administers any program in, provides 

22 supporting services for, teaches the subject 

23 matter of, or performs research in, health care 

24 services. 
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1 (3) INDIRECT PROVIDER OF HEALTH CARE.—

2 The term ‘‘indirect provider of health care’’ means 

3 an individual who—

4 (A) receives (either directly or through his 

or her spouse) more than 1 5 ⁄10 of his or her 

6 gross annual income from any one or combina7 tion of—

8 (i) fees or other compensation for pro9 vision of, research into, or instruction in, 

10 the provision of health care, 

11 (ii) entities engaged in the provision 

12 of health care or in such research or in13 struction, 

14 (iii) producing or supplying drugs, 

15 medical equipment, or other articles for in16 dividuals or entities for use in the provi17 sion of or in research into or instruction in 

18 the provision of health care, or 

19 (iv) entities engaged in producing 

20 drugs, medical equipment, or such other 

21 articles; 

22 (B) holds a fiduciary position with, or has 

23 a fiduciary interest in, any entity described in 

24 clause (ii) or (iv) of subparagraph (A); or 
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1 (C) is engaged in issuing any policy or con2 tract of individual or group health insurance or 

3 hospital or medical service benefits. 

4 (4) NATIONAL HEALTH BOARD.—The term 

5 ‘‘National Health Board’’ means the National 

6 Health Board of the Service. 

7 (5) SERVICE.—The term ‘‘Service’’ means the 

8 United States Health Service established in section 

9 101. 

10 (6) SERVICE-RELATED TERMS.—

11 (A) HEALTH CARE SERVICES.—The term 

12 ‘‘health care services’’ means the services de13 scribed in paragraphs (1) through (5) of section 

14 213(a). 

15 (B) SUPPLEMENTAL SERVICES.—The term 

16 ‘‘supplemental services’’ means the services de17 scribed in paragraphs (1), (2), and (3) of sec18 tion 213(b). 

19 (7) USER.—The term ‘‘user’’ means an indi20 vidual who is eligible under section 211 to receive 

21 health care services from the Service under this Act. 
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1 TITLE I—ESTABLISHMENT AND 

2 OPERATION OF THE UNITED 

3 STATES HEALTH SERVICE 

4 SEC. 101. ESTABLISHMENT OF THE SERVICE. 

5 (a) IN GENERAL.—There is established, as an inde6 pendent establishment of the executive branch of the 

7 United States, the United States Health Service. 

8 (b) AUTHORITY.—

9 (1) NATIONAL HEALTH BOARD.—The authority 

10 of the Service shall be exercised by the National 

11 Health Board and, in accordance with this Act and 

12 guidelines established by such Board, by local and 

13 regional authorities affiliated with the Board. 

14 (2) EMINENT DOMAIN AUTHORITY.—The Serv15 ice shall have the authority, under the power of emi16 nent domain, to acquire by condemnation under ju17 dicial process real estate for the Service for public 

18 purposes whenever it is necessary or advantageous 

19 to do so. 

20 (c) ADMINISTRATION.—The Board shall implement 

21 administrative measures as necessary to assure the equi22 table distribution and allocation of health care resources 

23 and services. 

24 (d) ACCOUNTABILITY AND CONTROL.—The Board 

25 shall establish mechanisms to assure accountable, rep-
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1 resentative and democratic governance of the Service and 

2 of health care facilities by health care users and workers, 

3 with limits on conflicts of interest as described in this Act. 

4 SEC. 102. APPOINTMENT OF THE NATIONAL HEALTH 

5 BOARD. 

6 The President shall, no later than 30 days after the 

7 date of the enactment of this Act, appoint 21 individ8 uals—

9 (1) who are 18 years of age or older; 

10 (2) who are concerned about the health care 

11 problems of the Nation; 

12 (3) who approximate the Nation’s population by 

13 race, sex, income, language, and region of residence, 

14 and approximate the percentage of rural and fron15 tier populations; and 

16 (4) no more than seven of whom are or have 

17 been health workers, indirect providers of health 

18 care, or members of the immediate family of such 

19 workers or indirect providers within 24 months of 

20 the date of such nomination, to serve as members of 

21 the National Health Board of the Service. 

22 SEC. 103. POWERS AND DUTIES OF THE NATIONAL HEALTH 

23 BOARD. 

24 The National Health Board shall—
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1 (1) establish the boundaries of health care de2 livery regions, in accordance with section 107; 

3 (2) establish procedures for creating local and 

4 regional authorities within each health care delivery 

5 region, to oversee and administer the delivery of 

6 health services, pursuant to section 104, and other 

7 provisions of this Act in their respective regions and 

8 local areas; 

9 (3) carry out such duties of the National 

10 Health Board as it deems necessary and consistent 

11 with the timetable given under this Act and the pur12 poses of the Service; and 

13 (4) provide for the recording of minutes of each 

14 of its meetings, and shall make such records avail15 able to the public for inspection and copying. 

16 SEC. 104. REPRESENTATION IN LOCAL AND REGIONAL AU17 THORITIES. 

18 The governing bodies of the local and regional au19 thorities created pursuant to section 103(b) shall consist 

20 of representatives of users resident in their local area or 

21 region and representatives of health workers employed by 

22 the Service in their local area or region. Representatives 

23 of such users shall comprise the majority of such rep24 resentatives and representatives of such health workers 

25 shall comprise a minority. 
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1 SEC. 105. PUBLIC ACCOUNTABILITY AND FINANCIAL DIS2 CLOSURE. 

3 (a) PROHIBITION OF CONFLICTS OF INTEREST.—

4 (1) IN GENERAL.—Individuals with direct or in5 direct conflicts of interest shall not serve on health 

6 boards or authorities. Subject to paragraph (2), such 

7 conflicts may consist of ownership of, employment 

8 in, or other financial affiliation with any industry in 

9 a position to profit or otherwise benefit from the ac10 tivities of the health board. 

11 (2) EXCEPTION.—Paragraph (1) shall not 

12 apply to employment as a health worker by the Serv13 ice as specified in this Act. 

14 (b) DISCLOSURE.—Candidates for health boards or 

15 authorities shall fully disclose any such potential conflicts 

16 of interest, and if elected or appointed shall sever any af17 filiations that could result in a conflict. 

18 SEC. 106. INSPECTOR GENERAL FOR HEALTH SERVICES. 

19 Within the United States Health Service there shall 

20 be an Office of the Inspector General for Health Services, 

21 to be headed by an Inspector General for Health Services, 

22 that shall have authority to ensure the effective operation 

23 of the services pursuant to this Act and to investigate and 

24 pursue any grievances against the National Health Board 

25 or its local authorities. The Inspector General shall have 
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1 the same authority as an Inspector General has under the 

2 Inspector General Act of 1978. 

3 SEC. 107. ESTABLISHMENT OF HEALTH CARE DELIVERY RE4 GIONS. 

5 (a) ESTABLISHMENT OF HEALTH CARE DELIVERY

6 REGIONS.—No later than 6 months after the appointment 

7 of members of the National Health Board, such Board 

8 shall establish, in accordance with this section, health care 

9 delivery regions throughout the United States.

10 (b) REQUIREMENTS FOR DELIVERY REGIONS.—Each 

11 health care delivery region shall meet the following re12 quirements: 

13 (1) The region shall be a contiguous geographic 

14 area appropriate for the effective governance, plan15 ning, and delivery of all health care and supple16 mental services under this Act for residents of the 

17 region. 

18 (2) The region shall have a population of not 

19 less than 500,000 and of not more than 3,000,000 

20 individuals, except that—

21 (A) the population of a region may be 

22 more than 3,000,000 if the region includes a 

23 standard metropolitan statistical area (as deter24 mined by the Office of Management and Budg-
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1 et) with a population of more than 3,000,000; 

2 and 

3 (B) the population of a region may be less 

4 than 500,000 if the National Health Board de5 termines that this is necessary to facilitate the 

6 delivery of health care and supplemental serv7 ices or the effective governance of the health 

8 program within such region. 

9 A region under subparagraph (B) may be a sparsely 

10 populated frontier area which consists of a very 

11 large or multi-state geographic area. 

12 (3) The boundaries of each region shall take 

13 into account—

14 (A) any economic or geographic barrier to 

15 the receipt of health care and supplemental 

16 services in nonmetropolitan areas, and 

17 (B) the differences in needs between non18 metropolitan and metropolitan areas in the 

19 planning, development, and delivery of health 

20 care and supplemental services. 

21 (c) MODIFICATION OF BOUNDARIES.—The National 

22 Health Board shall review the boundaries of regions no 

23 later than 2 years after each decennial national census, 

24 or upon receipt of and at such other times as it deems 

25 necessary, and may modify the boundary of any region 
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1 in which there has been a substantial shift of population 

2 justifying such modification or if such modification would 

3 better carry out the purposes of this Act, and if such modi4 fication is approved in a referendum of residents in an 

5 area whose regional identification would be changed by 

6 making such modification. 

7 (d) PROCESS.—At least 60 days prior to the estab8 lishment of the boundaries of any region, or modification 

9 of the boundaries, the National Health Board shall col10 laborate with its regional authorities to provide for—

11 (1) notice in the area which would be affected 

12 by the establishment of such boundaries of the 

13 boundaries proposed to be established, and of the 

14 date, time, and location of the public hearing on 

15 such establishment as provided in paragraph (2); 

16 and 

17 (2) a public hearing at which individuals can 

18 speak or present written statements relating to the 

19 establishment of such boundaries. 
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1 TITLE II—DELIVERY OF HEALTH 

2 CARE AND SUPPLEMENTAL 

3 SERVICES 

4 Subtitle A—Patients’ Rights in 

5 Health Care Delivery 

6 SEC. 201. BASIC HEALTH RIGHTS. 

7 The Service, in its delivery of health care services to 

8 users, shall ensure that every such individual is given the 

9 following basic health rights: 

10 (1) The right to receive high quality health care 

11 and supplemental services from any facility within 

12 the Service capable of providing such services with13 out charge and without discrimination on account of 

14 race, sex, age, religion, language, income, marital 

15 status, sexual orientation, dress, or previous health 

16 status. 

17 (2) The right to humane, respectful, dignified, 

18 and comforting health care, and to the reduction of 

19 pain and distressful symptoms. 

20 (3) The right to have all medically necessary or 

21 appropriate health services delivered in a convenient 

22 and timely manner. Any decision to deny or post23 pone such necessary or appropriate care shall be 

24 made only on the basis of temporary and reasonable 

25 limitations in the availability of service personnel 
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1 and physical facilities. Users shall have the oppor2 tunity for timely and effective appeal of any decision 

3 to deny or postpone care. 

4 (4) The right to choose the health workers who 

5 shall be responsible for, and the health facilities in 

6 which to receive, the individual’s health care serv7 ices. 

8 (5) The right of access to all information, in9 cluding the individual’s health records and the med10 ical dictionary produced under section 433(b), which 

11 promotes an understanding of health. 

12 (6) The right to have all health care informa13 tion, reports, and educational materials translated 

14 into the individual’s primary language. 

15 (7) The right to receive, prior to the delivery of 

16 any health care service, a careful, prompt, and intel17 ligible—

18 (A) explanation of the indications, diag19 noses, benefits, side effects, and risks involved 

20 in the delivery of such service, and a description 

21 of all medically necessary or appropriate alter22 natives to such service (including no treatment); 

23 (B) answer to any question relating to 

24 such health care service; and 
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1 (C) explanation of one’s health rights de2 scribed in this subtitle, and the right to have 

3 such health care service delivered only with the 

4 individual’s prior, voluntary, written consent. 

5 (8) The right to refuse the initial or continuing 

6 delivery of any health care service whenever such re7 fusal does not directly endanger the public health or, 

8 in accordance with State law, the health of the indi9 vidual if the individual is dangerous to himself or 

10 herself.

11 (9) The right to have all individually identifi12 able information and documents treated confiden13 tially and not disclosed (except for statistical pur14 poses and for the control of communicable diseases, 

15 drug abuse, and child abuse) without the individual’s 

16 prior, voluntary, and written consent. 

17 (10) The right of access at all times to individ18 uals or groups for counseling, health information, 

19 and assistance on health matters, including access to 

20 user advocates who shall—

21 (A) assist users in choosing the most ap22 propriate sites from which to receive health 

23 services and the most appropriate health work24 ers from whom to receive such services; 
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1 (B) provide counseling and assistance to 

2 users in filing complaints; and 

3 (C) investigate instances of poor quality 

4 services or improper treatment of users and 

5 bring such instances to the attention of the ap6 plicable authority. 

7 (11) The right to be accompanied and visited at 

8 any time by a friend, relative, or independent advo9 cate of the individual’s choosing, and the right to 

10 have routine services, such as feeding, bathing, 

11 dressing, and bedding changes, performed by a 

12 friend or relative, if the individual so chooses. 

13 (12) The right, in the event of terminal illness, 

14 to die with a maximum degree of dignity, to be pro15 vided all necessary symptom relief, to be provided 

16 (and for the individual’s family to be provided) coun17 seling and comfort, and to be allowed (if desired) to 

18 die at home. 

19 (13) The right of access to a complaint and 

20 grievance system and to legal assistance to enforce 

21 these rights. 

22 SEC. 202. RIGHT TO PAID LEAVE TO RECEIVE HEALTH 

23 CARE SERVICES. 

24 (a) AMENDMENT TO FAIR LABOR STANDARDS

25 ACT.—The Fair Labor Standards Act of 1938 is amended 
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1 by inserting after section 7 (29 U.S.C. 207) the following 

2 new section: 

3 ‘‘MINIMUM HEALTH LEAVE COMPENSATION

4 ‘‘SEC. 7A. Each employee of any employer who in any 

5 workweek is engaged in commerce or in the production 

6 of goods for commerce, or is employed in an enterprise 

7 engaged in commerce or in the production of goods for 

8 commerce, shall be entitled to receive from the employer, 

9 for each 35 hours he is employed by the employer (not 

10 counting more than 35 hours in any workweek), com11 pensation for one hour of employment at the regular rate 

12 at which the employee is employed (as that term is used 

13 in section 7 of this Act) for an hour—

14 ‘‘(1) during the period of 52 weeks beginning 

15 with the workweek with which the entitlement is 

16 earned, and 

17 ‘‘(2) during which the employee is unable to 

18 work because of the need for the employee (or a de19 pendent of that employee) to receive necessary 

20 health care services.’’. 

21 (b) CONFORMING AMENDMENTS.—The Fair Labor 

22 Standards Act of 1938 is further amended—

23 (1) in section 3(o), by striking ‘‘sections 6 and 

24 7’’ and inserting ‘‘sections 6, 7, and 7A’’; 

25 (2) in section 13—
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1 (A) by striking ‘‘and 7’’ in subsection (a) 

2 before paragraph (1) and inserting ‘‘, 7, and 

3 7A’’; 

4 (B) by striking ‘‘sections 6 and 7’’ in sub5 section (a)(3) and inserting ‘‘sections 6, 7, and 

6 7A’’; and 

7 (C) by inserting ‘‘7A,’’ in subsections (d) 

8 and (f) after ‘‘7,’’ each place it appears; 

9 (3) in section 14(d), by striking ‘‘6 and 7’’ and 

10 inserting ‘‘6, 7, and 7A’’; 

11 (4) in section 15(a), by striking ‘‘section 6 or 

12 section 7’’ and inserting ‘‘section 6, 7, or 7A’’; 

13 (5) in section 16—

14 (A) by striking ‘‘section 6 or section 7’’ in 

15 subsection (b) and inserting ‘‘section 6, 7, or 

16 7A’’; 

17 (B) by striking ‘‘or their unpaid overtime 

18 compensation’’ in subsection (b) and inserting 

19 ‘‘their unpaid overtime compensation, or their 

20 unpaid health leave compensation’’; 

21 (C) by inserting ‘‘or of unpaid health leave 

22 compensation’’ in subsection (b) after ‘‘amount 

23 of unpaid overtime compensation’’; 
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1 (D) by striking ‘‘section 6 or 7’’ in the 

2 first sentence of subsection (c) and inserting 

3 ‘‘section 6, 7, or 7A’’; 

4 (E) by striking ‘‘unpaid overtime com5 pensation’’ in the first sentence of subsection 

6 (c) and inserting ‘‘, unpaid overtime compensa7 tion, or unpaid health leave compensation’’; 

8 (F) by striking ‘‘or overtime compensa9 tion’’ in the second sentence of subsection (c) 

10 and inserting ‘‘, overtime compensation, or 

11 health leave compensation’’; and 

12 (G) by striking ‘‘or unpaid overtime com13 pensation under sections 6 and 7’’ in the third 

14 sentence of subsection (c) and inserting ‘‘, un15 paid overtime compensation, or unpaid health 

16 leave compensation under sections 6, 7, and 

17 7A’’; and 

18 (6) in section 18—

19 (A) by inserting ‘‘or minimum health leave 

20 compensation higher than the minimum health 

21 leave compensation established under this Act’’ 

22 in the first sentence of subsection (a) before ‘‘, 

23 and no provision’’; and 

24 (B) by inserting ‘‘, or justify any employer 

25 in reducing health leave compensation provided 
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1 by him which is in excess of the applicable min2 imum health leave compensation under this 

3 Act’’ before the period at the end of the second 

4 sentence of subsection (a). 

5 Subtitle B—Eligibility for, Nature 

6 of, and Scope of Services Pro7 vided by the Service 

8 SEC. 211. ELIGIBILITY FOR SERVICES. 

9 (a) IN GENERAL.—All individuals while within the 

10 United States are eligible to receive health care and sup11 plemental services under this Act.

12 (b) UNITED STATES DEFINED.—For purposes of this 

13 section, the term ‘‘United States’’ includes Indian reserva14 tions, the District of Columbia, the Commonwealth of 

15 Puerto Rico, the Virgin Islands, Guam, Samoa, and the 

16 Northern Mariana Islands. 

17 SEC. 212. ENTITLEMENT TO SERVICES. 

18 (a) IN GENERAL.—Except as provided in subsection 

19 (b), the Service shall, on and after the effective date of 

20 health services, provide users with all health care services 

21 and supplemental services described in section 213 which 

22 the Service determines, in accordance with this title, to 

23 be necessary or appropriate for the promotion and en24 hancement of health, for the prevention of disease, and 
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1 for the diagnosis and treatment of, and rehabilitation fol2 lowing, injury, disability, or disease. 

3 (b) EXCLUSION.—Services provided under this Act 

4 shall not include personal comfort or cosmetic services un5 less the National Health Board or its designee determines 

6 that the services are required for health-related reasons. 

7 SEC. 213. PROVISION OF HEALTH CARE AND SUPPLE8 MENTAL SERVICES. 

9 (a) IN GENERAL.—The Service shall provide in the 

10 United States the following health care services in or 

11 through facilities established by the Service—

12 (1) the promotion of health and well-being 

13 through health education programs to be carried out 

14 in facilities of the Service as well as in workplaces, 

15 schools, and elsewhere utilizing all appropriate 

16 media, and by assisting other Government agencies 

17 in taking appropriate actions to promote health and 

18 well-being; 

19 (2) the prevention of illness, injury, and death 

20 through education and advocacy addressed to the so21 cial, occupational, and environmental causes of ill 

22 health; through the provision of appropriate preven23 tive services including social, medical, occupational, 

24 and environmental health services, on both an emer25 gency and sustained basis; through screening and 
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1 other early detection programs to identify and ame2 liorate the primary causes of ill health; and, where 

3 appropriate, through actions taken on an emergency 

4 basis to halt environmental threats to life and 

5 health; 

6 (3) the diagnosis and treatment of illness and 

7 injury, including emergency medical services, com8 prehensive outpatient and inpatient health care serv9 ices, occupational health services, mental health 

10 services, dental care, vision care, long-term care, and 

11 home health services; 

12 (4) the rehabilitation of the sick and disabled, 

13 including physical, psychological, occupational, and 

14 other specialized therapies; and 

15 (5) the provision of drugs, therapeutic devices, 

16 appliances, equipment, and other medical supplies 

17 (including eyeglasses, other visual aids, dental aids, 

18 hearing aids, and prosthetic devices) certified effec19 tive in the National Pharmacy and Medical Supply 

20 Formulary (published under section 432(a)) and fur21 nished or prescribed by authorized health workers. 

22 (b) SUPPLEMENTAL SERVICES.—The Service shall 

23 provide the following services supplemental to the delivery 

24 of health care services in or through health care facilities 

25 established by the Service—
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1 (1) ambulance and other transportation services 

2 to insure ready and timely access to necessary health 

3 care; 

4 (2) child care services for individuals who, dur5 ing the time they receive outpatient health care serv6 ices from the Service or are working in a health care 

7 facility of the Service, are responsible for a child’s 

8 care; 

9 (3) homemaking and home health services—

10 (A) to enable the provision of inpatient 

11 health services at a health care facility of the 

12 Service to an individual who has the sole re13 sponsibility for the care 

14 (i) of a child under 15 years of age, 

15 or 

16 (ii) of a physically or mentally handi17 capped individual who requires the care of 

18 another individual, and 

19 (B) for the bedfast or severely handicapped 

20 individual; and 

21 (4) such counseling and social service assistance 

22 as will avoid the unnecessary provision of health care 

23 services. 

24 (c) LOCAL PUBLIC HEALTH SERVICES.—The Service 

25 shall maintain the functions, especially those related to en-
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1 vironmental health and the prevention of illness, currently 

2 performed by the departments of health of the States and 

3 localities, to the extent consistent with Federal, State, and 

4 local law, and shall cooperate with State and local govern5 ments in its conduct of such functions. 

6 (d) EMERGENCY HEALTH CARE SERVICES.—The 

7 Service shall provide, at rates established by the National 

8 Health Board, for reimbursement of the cost of emergency 

9 health care services furnished in facilities not operated by 

10 the Service or by health workers not employed by the Serv11 ice, when an injury or acute illness requires immediate 

12 medical attention under circumstances making it medi13 cally impractical for the ill or injured individual to receive 

14 care in a Service facility or by an employee of the Service. 

15 Subtitle C—Health Care Facilities 

16 and Delivery of Health Care 

17 Services 

18 SEC. 221. ESTABLISHMENT OF HEALTH CARE FACILITIES 

19 AND DISTRIBUTION OF DELIVERY OF 

20 HEALTH CARE AND OTHER SERVICES. 

21 (a) HEALTH SERVICE AREAS.—The National Health 

22 Board, in consultation with local authorities and residents 

23 of the local communities affected, shall establish such 

24 health care facilities as are necessary to provide all nec25 essary comprehensive primary and specialized health care 
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1 services, including distributing such health care resources 

2 in a manner as to overcome present shortages and ensure 

3 equitable access for every resident to needed health care 

4 resources. In establishing such facilities, the National 

5 Health Board shall rely primarily on existing political 

6 boundaries for the purposes of allocating health services, 

7 including cities, counties, perinatal services regions, 

8 States, and Federal Medicare regions, and shall determine 

9 the need to establish additional or supplementary regional 

10 health service areas that may cross existing boundaries.

11 (b) HEALTH CARE FACILITIES.—

12 (1) IN GENERAL.—The National Health Board 

13 and its local authorities shall, not later than the ef14 fective date of health services and to the maximum 

15 extent feasible, establish and maintain such health 

16 care facilities as are necessary for the efficient and 

17 effective delivery to individuals of comprehensive pri18 mary health care services (defined in paragraph (2)), 

19 specialized health care services (defined in para20 graph (3)), special services (defined in paragraph 

21 (4)) and community-oriented health measures (de22 fined in paragraph (5)). Such health care facilities 

23 shall be established and maintained in a manner 

24 that, as soon as possible and to the greatest extent 
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1 feasible, provides services in each community 

2 through a single comprehensive health center. 

3 (2) COMPREHENSIVE PRIMARY HEALTH CARE

4 SERVICES DEFINED.—As used in paragraph (1), the 

5 term ‘‘comprehensive primary health care services’’ 

6 means those basic outpatient health care services 

7 typically needed for the promotion of health and the 

8 prevention and treatment of common illnesses and 

9 includes the following health care services—

10 (A) general primary medical and dental 

11 care, including diagnosis and treatment, routine 

12 physical examinations, laboratory, and 

13 radiologic services, and home visits by health 

14 workers, as appropriate; 

15 (B) preventive health services, including at 

16 least immunizations, nutrition counseling and 

17 consultation, and periodic screening and assess18 ment services; 

19 (C) children’s health services, including as20 sessment of growth and development, education 

21 and counseling on childrearing and child devel22 opment, and school and day care center health 

23 services; 

24 (D) obstetrical and gynecological services, 

25 including family planning and contraceptive 
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1 services, pregnancy (prenatal and postnatal) 

2 and abortion counseling and services; 

3 (E) comprehensive geriatric services; 

4 (F) vision and hearing examinations and 

5 provision of eyeglasses and other visual aids 

6 and hearing aids; 

7 (G) 24-hour emergency medical services; 

8 (H) provision of pharmaceuticals and 

9 therapeutic devices, and medical appliances and 

10 equipment; 

11 (I) mental health services, including psy12 chological and psychiatric counseling; 

13 (J) home health services; and 

14 (K) occupational safety and health serv15 ices, including screening, diagnosis, treatment, 

16 and education. 

17 (3) SPECIALIZED HEALTH CARE SERVICES DE18 FINED.—As used in paragraph (1), the term ‘‘spe19 cialized health care services’’ means those health 

20 care services of a specialized nature (whether deliv21 ered in an inpatient or outpatient setting) which, ap22 plying guidelines established by the National Health 

23 Board, may be provided most effectively and effi24 ciently in a community setting. 
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1 (4) SPECIAL SERVICES DEFINED.—As used in 

2 paragraph (1), the term ‘‘special services’’ means 

3 supportive services and the facilities (including nurs4 ing homes and multiservice centers) in which such 

5 services are provided for individuals who are phys6 ically or mentally handicapped, mentally ill, infirm, 

7 or chronically ill, so as to promote the integration 

8 and functioning of such individuals within the com9 munity. 

10 (5) COMMUNITY-ORIENTED HEALTH MEASURES

11 DEFINED.—As used in paragraph (1), the term 

12 ‘‘community-oriented health measures’’ includes ef13 forts to focus organized community activities upon 

14 the promotion of health and the prevention of illness 

15 and injury, support for self-help and mutual aid 

16 groups offering health promotion and rehabilitative 

17 support programs; surveillance of potential threats 

18 to community health, and prompt action to protect 

19 against such threats, and includes outreach efforts 

20 to ensure that all residents are aware of and able to 

21 utilize the health services of the Service, as needed. 

22 (b) ALLOCATION OF HOSPITALS.—The National 

23 Health Board, in consultation with its local authorities, 

24 shall periodically determine the necessity to establish and 

25 maintain inpatient and other specialized health care facili-
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1 ties in particular locations. Where found appropriate, it 

2 shall establish and maintain—

3 (1) general hospitals for the efficient and effec4 tive delivery of health care services to individuals re5 quiring inpatient diagnosis, treatment, care, and re6 habilitation for injury or illness; and 

7 (2) such other health care facilities as are nec8 essary, using guidelines established by the National 

9 Health Board to promote the efficient and effective 

10 delivery of health care services. 

11 In addition, the Board shall distribute and provide such 

12 health care services of a specialized nature (whether deliv13 ered in an inpatient or outpatient setting) as may be pro14 vided most effectively and efficiently. 

15 (c) SPECIALIZED SERVICES.—The Board shall, not 

16 later than the effective date of health services, establish 

17 and maintain—

18 (1) specialized medical facilities for the efficient 

19 and effective delivery of highly specialized health 

20 care services, using guidelines it shall establish, to 

21 individuals requiring highly specialized treatment, 

22 care, and rehabilitation for injury or illness; 

23 (2) health care and supplemental services for 

24 individuals whose health care are related to occupa25 tional or other factors, including individuals residing 
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1 within a region on a temporary or seasonal basis (in2 cluding migratory agricultural workers) and individ3 uals confined to prisons and other correctional insti4 tutions; and 

5 (3) such other health care facilities as are nec6 essary to promote the efficient and effective delivery 

7 of health care services. 

8 (d) HEALTH SERVICES.—States and the National 

9 Health Board, through its local and regional authorities, 

10 shall provide the following through health care facilities 

11 established pursuant to this section: 

12 (1) Health promotion through education on per13 sonal health matters, nutrition, the avoidance of ill14 ness, and the effective use of health care services 

15 with particular emphasis on the appropriate and safe 

16 use (discouraging the overuse) of drugs and medical 

17 techniques. 

18 (2) Maintenance and appropriate transmission 

19 and transferal of personal health records for each 

20 user of the services consistent with section 201(9). 

21 (3) Referral services, including referrals, where 

22 appropriate, to other health care facilities. 

23 (4) Supplemental services (described in section 

24 213(b)), as appropriate. 
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1 (5) Assistance to individuals who, because of 

2 language or cultural differences or educational or 

3 other handicaps, are unable fully to utilize the serv4 ices available from and delivered by the Board. 

5 (6) Information (A) on the rights ensured 

6 under this Act, (B) on the guidelines and standards 

7 established by the Board, and (C) on how the Board 

8 is implementing such rights and applying such 

9 guidelines and standards. 

10 (7) Information on the grievance mechanisms 

11 established pursuant to subtitle A of title IV and on 

12 legal services available to pursue grievances against 

13 the Board. 

14 (8) Environmental health inspection and moni15 toring services, including investigations relating to 

16 the prevention of communicable diseases, in coopera17 tion with State and local authorities. 

18 (9) Research and data gathering on the leading 

19 causes of ill health and injury and on health care de20 livery, in accordance with section 421. 

21 (10) In the case of each inpatient health care 

22 facility, discharge planning and followup services (A) 

23 to identify patients who will need continuing care 

24 after discharge from the facility and (B) to plan, 

25 with the patient and the patient’s family, arrange-
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1 ments and referrals to meet such postdischarge 

2 needs. 

3 (e) AUTHORITIES.—

4 (1) EFFECTIVE DELIVERY.—In its establish5 ment of health care facilities, the National Health 

6 Board shall seek to minimize fragmentation and du7 plication in delivery of health care and other services 

8 so as to promote the effective and efficient delivery 

9 of such services. 

10 (2) COORDINATION.—The Board shall provide 

11 mechanisms to coordinate care across political and 

12 geographic boundaries as necessary. 

13 (3) ASSURING AVAILABILITY AND ACCESSI14 BILITY OF SERVICES.—The Board shall take what15 ever additional steps are necessary to ensure that all 

16 of the health services required under this title are 

17 available and accessible in a timely manner to 

18 adults, infants, children, and individuals with dis19 abilities in its region. Toward that end, it shall—

20 (A) ensure that users have access to a suf21 ficient number of each category of health work22 er, including primary care providers, specialists, 

23 and other health care professionals, in a man24 ner so that, to the maximum extent possible, 

25 such providers are geographically accessible to 
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1 all residences and workplaces within the region 

2 and are culturally and linguistically appro3 priate; 

4 (B) ensure that services are available in a 

5 manner which ensures continuity of care, avail6 ability within reasonable hours of operation, 

7 and include emergency and urgent care services 

8 which shall be accessible at all times; 

9 (C) ensure that any process established to 

10 coordinate care shall ensure ongoing direct ac11 cess to relevant specialists and shall not impose 

12 an undue burden on users with chronic health 

13 conditions; 

14 (D) ensure that appropriate steps are 

15 taken to eliminate any transportation or other 

16 barriers to the timely receipt of services; 

17 (E) ensure that a user who has a severe, 

18 complex, or chronic condition shall have access 

19 to the most appropriate health care coordinator 

20 (as defined in paragraph (4)(A)); and 

21 (F) ensure that priorities in the use of 

22 services and facilities shall be set by the appro23 priate health care professionals using criteria of 

24 medical necessity and that any limitations or 

25 delay in access to services shall be based only 
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1 on limits of available service personnel and 

2 physical facilities. 

3 (4) DEFINITIONS.—For purposes of this sub4 section: 

5 (A) HEALTH CARE COORDINATOR.—The 

6 ‘‘health care coordinator’’ means a health work7 er who performs case management (as defined 

8 in subparagraph (B)) functions in consultation 

9 with the health care team, the patient, family, 

10 and community. 

11 (B) CASE MANAGEMENT.—The term ‘‘case 

12 management’’ means a coordinated set of activi13 ties conducted for the management of an indi14 vidual user’s serious, complicated, protracted or 

15 chronic health conditions in order to ensure 

16 cost-effective and benefit maximizing treatment. 

17 (f) GUIDELINES.—The National Health Board shall 

18 establish guidelines for distribution and coordination of 

19 the delivery of health care and other services described in 

20 this section and shall, before the effective date of health 

21 services, plan and facilitate the transition to the new dis22 tribution of health care facilities and health workers to 

23 be effected on and after that date. 

24 (g) USE OF EVIDENCE-BASED CLINICAL DECISION

25 CRITERIA.—
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1 (1) IN GENERAL.—The National Health Board 

2 shall authorize the National Institute of Evaluative 

3 Clinical Research described in section 422 to estab4 lish evidence-based clinical decision criteria, where 

5 feasible, that shall apply throughout the Nation.

6 (2) CLINICAL DECISION CRITERIA DEFINED.—

7 For purposes of this section, the term ‘‘clinical deci8 sion criteria’’ means the recorded (written or other9 wise) screening procedures, decision abstracts, clin10 ical protocols, and practice guidelines used as an im11 portant basis to determine the necessity and appro12 priateness of health care services, in combination 

13 with the facts of particular cases, the judgment of 

14 health care professionals, and the preferences of 

15 users. Such criteria shall be clearly documented and 

16 available to all health workers and shall include a 

17 mechanism for periodically updating such criteria. 

18 (h) NOTICE OF DETERMINATIONS.—The National 

19 Health Board, and its local and regional authorities, shall 

20 provide users with timely notice of any determination to 

21 provide, deny, or delay provision of a service, and informa22 tion about the relevant clinical decision criteria upon 

23 which such determination is based, if any. Such notifica24 tion shall include information concerning the appropriate 

25 procedure to appeal such decision. 
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1 (i) ACCOUNTABILITY.—In the case that the Health 

2 Service fails on the effective date of health services, to sub3 stantially and materially provide health care and supple4 mental services in accordance with this section, redress 

5 and alternative sources of care shall be authorized by an 

6 independent authority accountable to Congress and State 

7 legislatures. Such redress may include—

8 (1) requiring the provision of services; and 

9 (2) providing reimbursement for the provision 

10 of specified health care services in accordance with 

11 procedures and schedules in effect under title XVIII 

12 of the Social Security Act immediately before the ef13 fective date of health services. 

14 SEC. 222. OPERATION AND INSPECTION OF HEALTH CARE 

15 FACILITIES. 

16 (a) ESTABLISHMENT OF POLICIES.—

17 (1) IN GENERAL.—Each health care facility 

18 shall be subject to policies and organizational plans 

19 consistent with this section and with parts A and C 

20 of title III (relating to the health labor force) for the 

21 operation of such facility and shall establish proce22 dures to ensure that the facility is operated in ac23 cordance with such policies and plans. 

24 (2) HEALTH WORKER AND USER CONTROL.—

25 The National Health Board and its regional and 
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1 local authorities shall establish policies and mecha2 nisms for control of health care facilities by health 

3 care workers who are employed in, and users who re4 ceive services from, the respective facility, and shall 

5 promulgate rules preventing a financial conflict of 

6 interest by decisionmaking bodies. 

7 (b) EMPLOYMENT RESTRICTIONS.—

8 (1) IN GENERAL.—No individual entitled to 

9 make decisions regarding establishment, allocation, 

10 or operation of a health facility may engage in the 

11 private delivery of health care services. 

12 (2) PRIVATE DELIVERY OF HEALTH CARE

13 SERVICES DEFINED.—For the purposes of this sub14 section, the term ‘‘private delivery of health care 

15 services’’ means the delivery of health care services 

16 for which an individual, group, or organization re17 ceives remuneration from any source other than the 

18 Health Service Trust Fund established in section 

19 511. 

20 (c) OPERATIONS OF HEALTH CARE FACILITIES.—

21 (1) HOURS OF OPERATION.—Any health care 

22 facility which provides health care services on an 

23 outpatient basis shall be open during hours that will 

24 permit all users to make use of such services. 
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1 (2) EFFECTIVE DELIVERY.—In its establish2 ment of health care facilities under this section, the 

3 Board shall seek to minimize fragmentation and du4 plication in delivery of health care and other services 

5 so as to promote the effective and efficient delivery 

6 of such services. 

7 SEC. 223. PROVISION OF HEALTH SERVICES RELATING TO 

8 REPRODUCTION AND CHILDBEARING. 

9 (a) PROVISION OF SERVICES.—

10 (1) IN GENERAL.—The following services shall 

11 be provided: 

12 (A) FAMILY PLANNING.—

13 (i) Complete information on contra14 ception and provision of birth control ma15 terials or medication of the individual’s 

16 choosing. 

17 (ii) Complete and effective evaluation 

18 and treatment of sexually transmitted dis19 eases and diseases of the reproductive or20 gans. 

21 (iii) Complete information and coun22 seling with respect to pregnancy, child23 bearing, and possible outcomes involving 

24 genetically induced anomalies. 

25 (B) PREGNANCY.—
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1 (i) Complete and effective pregnancy 

2 testing. 

3 (ii) Prenatal services, including phys4 ical examination, counseling, and instruc5 tion of expectant parents in nutrition, 

6 childrearing, and children’s health care 

7 services. 

8 (iii) Safe, comfortable, and convenient 

9 abortion services. 

10 (iv) Counseling for women in conjunc11 tion with the provision of all gynecologic, 

12 female contraceptive, and abortion services 

13 and counseling for men on male fertility14 related services. 

15 (2) VOLUNTARY.—The services described in 

16 paragraph (1) shall be delivered without coercion or 

17 harassment, with complete confidentiality, and with18 out prior approval of individuals other than the indi19 vidual receiving the services. 

20 (3) ACCOMPANIMENT.—An individual shall be 

21 permitted to be accompanied by a person of the indi22 vidual’s choice during the provision of the services 

23 described in paragraph (1) to the extent this would 

24 not significantly increase the medical risk to the in25 dividual. 
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1 (b) VOLUNTARY CONSENT.—No health care provider 

2 may perform upon an individual a treatment or procedure 

3 (other than a treatment or procedure required to preserve 

4 the life of the individual) which could reasonably be ex5 pected to affect the individual’s capacity to reproduce chil6 dren, unless—

7 (1) the individual has given voluntary written 

8 consent to the treatment or procedure after being 

9 given complete information on the effect of the 

10 treatment or procedure on the individual’s reproduc11 tive capacity, and on possible alternative treatments 

12 and procedures, at least 30 days before beginning 

13 the treatment or procedure, and 

14 (2) the individual has, after such 30-day wait15 ing period, again given written consent to the per16 formance of the treatment or procedure, except that 

17 in the case of a woman who has given initial written 

18 consent to a sterilization she may be sterilized in 

19 less than 30 days following such consent (but in no 

20 case in less than 72 hours)—

21 (A) if she had given initial written consent 

22 at least 30 days before her anticipated delivery 

23 date, she delivers before the anticipated date, 

24 and the sterilization is performed at the time of 

25 delivery; 
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1 (B) if she undergoes emergency abdominal 

2 surgery within the 30-day waiting period and 

3 the sterilization is concurrent with the abdom4 inal surgery; or 

5 (C) in the case of an elective sterilization 

6 procedure, such as tubal ligation or vasectomy, 

7 that is scheduled and performed separately 

8 from the act of childbirth, where prior informed 

9 consent is provided and the procedure is per10 formed at the next subsequent or any later 

11 medical visit after informed consent is obtained. 

12 (c) BREAST CANCER TREATMENT.—The National 

13 Health Board shall insure that, before a mastectomy or 

14 other breast cancer treatment is performed on a woman, 

15 the woman shall be provided with complete information 

16 on the complete range of medical options available for 

17 treatment of her condition and the risks and side effects 

18 of each option and an opportunity to consult individuals 

19 of her choice, and shall have given voluntary written con20 sent to such procedure. 

21 (d) BIRTHING OPTIONS.—The National Health 

22 Board shall provide that a woman giving birth to an infant 

23 shall have the right to choose from a complete range of 

24 childbirth options including—
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1 (1) giving birth at home, in a birth center (if 

2 available), or in a hospital; 

3 (2) the presence during childbirth of a person 

4 or persons of her choosing; 

5 (3) the position for labor and delivery which she 

6 chooses; 

7 (4) caring for her infant at her bedside; 

8 (5) feeding her infant according to the method 

9 and schedule of her choice; and 

10 (6) selecting the birth attendant of her own 

11 choice. 

12 She shall be provided with information on the benefits, 

13 risks, and side effects of each option and an opportunity 

14 to consult individuals and groups of her choosing for infor15 mation and assistance on these options. 

16 TITLE III—HEALTH LABOR 

17 FORCE 

18 Subtitle A—Job Categories and 

19 Certification 

20 SEC. 301. EFFECT OF STATE LAW. 

21 Notwithstanding any law of a State or political sub22 division to the contrary, the Service, acting in accordance 

23 with the provisions of this Act, shall be the sole judge of 

24 the qualifications of its employees. 
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1 SEC. 302. QUALIFICATIONS OF HEALTH WORKERS. 

2 (a) CERTIFICATION OF COMPETENCE.—The National 

3 Health Board shall establish procedures which will ensure 

4 that, except in emergency situations, any work which is 

5 classified under a job category established under this sub6 title is performed by a health worker who at the time of 

7 such work was—

8 (1) certified (in accordance with this subtitle) 

9 as competent to perform the work under such job 

10 category, and 

11 (2) authorized to perform such work by the em12 ployer of such worker. 

13 (b) PERIODIC ASSESSMENTS.—There shall be peri14 odic review and assessment of the competency of such 

15 workers to perform the work within their job category, and 

16 opportunities for health workers to be assessed and cer17 tified with respect to skills required for advancement to 

18 other job categories. 

19 SEC. 303. ESTABLISHMENT OF JOB CATEGORIES AND CER20 TIFICATION STANDARDS. 

21 (a) IN GENERAL.—

22 (1) CLASSIFICATION.—The National Health 

23 Board shall establish such guidelines for the classi24 fication, certification, and employment of health 

25 workers by job category as it determines to be nec26 essary—
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1 (A) to ensure that health workers who per2 form work for the Service which requires spe3 cialized skills have demonstrated that they pos4 sess such skills, 

5 (B) to expand the roles of health workers 

6 to enable them to participate in health care de7 livery to the maximum extent consistent with 

8 their skills, and 

9 (C) to provide for affiliation of health 

10 workers with health care facilities at the com11 munity, district, and regional levels. 

12 These guidelines shall permit alternative approaches 

13 to healing, and practitioners skilled in such ap14 proaches, when these approaches have not been dem15 onstrated to be injurious to health. 

16 (2) CONSIDERATIONS.—In establishing guide17 lines under paragraph (1), the National Health 

18 Board shall provide for (A) sufficient flexibility to 

19 permit utilization of health workers most effectively 

20 to meet the health needs of the region, and (B) suf21 ficient uniformity to permit mobility of health work22 ers among the regions. 

23 (b) CERTIFICATION STANDARDS.—

24 (1) ESTABLISHMENT.—For each job category 

25 (other than a job category determined by the Na-
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1 tional Health Board to involve highly specialized 

2 skills requiring advanced specialty training), the Na3 tional Health Board shall, taking into account the 

4 guidelines established under subsection (a), establish 

5 certification standards which shall specify—

6 (A) the functions performed by a health 

7 worker employed in such job category;

8 (B) the skills required in the course of 

9 properly performing work under such job cat10 egory; 

11 (C) the initial and continuing training, ex12 perience, and performance which must be un13 dertaken or demonstrated by a health worker to 

14 achieve and maintain competency to perform 

15 the work within such job category; and 

16 (D) the curriculum which a health worker 

17 must follow in studies in a health team school 

18 (established under subtitle B) to demonstrate 

19 sufficient competence to satisfy the specification 

20 of subparagraph (C) for such job category. 

21 (2) SPECIFICATIONS.—For each job category 

22 established and determined by the National Health 

23 Board to involve highly specialized skills requiring 

24 advanced specialty training, the National Health 
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1 Board shall make the specifications described in sub2 paragraphs (A) through (D) of paragraph (1). 

3 (3) PERIODIC REVIEW.—Standards for a job 

4 category under this subsection shall be periodically 

5 reviewed to supplement, modify, or eliminate such 

6 standards as will facilitate the delivery of quality 

7 health care services under this Act. 

8 (4) QUALITY PROTECTION.—

9 (A) PROHIBITION OF DOWNGRADES OF

10 LEVELS.—No individual health facility adminis11 trator is authorized to downgrade the level of 

12 skill, license or certification required to perform 

13 duties delineated by the Board. 

14 (B) REVIEW.—

15 (i) REVIEW OF STAFFING CHANGES.—

16 Upon enactment of this Act, the Board 

17 shall convene a national level task force to 

18 review the impact on the safety and health 

19 of patients and workers of downgrading 

20 and deskilling of health care job categories 

21 by replacing licensed with unlicensed work22 ers during the 1990s, particularly in the 

23 nursing area, and to recommend remedies 

24 as appropriate. 
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1 (ii) WHISTLEBLOWER PROTECTION.—

2 Health care workers who report com3 promises in the quality of care shall not be 

4 subjected to recriminations. 

5 (C) WORKFORCE STAFFING LEVELS.—The 

6 Board may establish health workforce staffing 

7 levels as it determines will promote the delivery 

8 of quality health care services. 

9 Subtitle B—Education of Health 

10 Workers 

11 SEC. 311. HEALTH TEAM SCHOOLS. 

12 (a) ESTABLISHMENT.—

13 (1) IN GENERAL.—Except as provided in para14 graph (2), the Board shall establish a procedure for 

15 converting existing educational facilities for health 

16 services workers to create health team schools (each 

17 in this subtitle referred to as a ‘‘school’’) in accord18 ance with this section to provide programs of initial 

19 and continuing basic education in health care deliv20 ery for health workers in all job categories, and to 

21 provide initial continuing advanced education in 

22 health care specialties and health science specialty 

23 fields. Such schools shall be established and func24 tioning not later than 4 years after the effective date 

25 of health services. 
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1 (2) USE OF FUNDS.—Schools shall be funded 

2 exclusively by the Service, shall not charge nor ac3 cept tuition or fees for enrollment, and shall provide 

4 each student with an adequate allowance for living 

5 expenses, educational supplies, and any child care 

6 expenses. 

7 (b) OPERATIONAL PRINCIPLES.—Schools shall be op8 erated and maintained in accordance with the following 

9 principles: 

10 (1) The activities of each school shall be de11 signed to meet the health needs of the population. 

12 (2) The number of students enrolled in each 

13 educational program in a school shall be based on 

14 the needs for health workers within a given area, de15 fined by geographic and political boundaries. 

16 (3) Schools shall integrate the education of 

17 health workers in the different job categories (estab18 lished under subtitle A) so as to permit health work19 ers to be educated and certified for successively 

20 higher levels of health care work. 

21 (4) Each school’s admissions policies, cur22 riculum policies, faculty hiring procedures, and gov23 ernance plan shall be established and implemented 

24 in accordance with subsections (c) through (f), re25 spectively, and with the fullest possible participation 
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1 of the community health workers, staff, and students 

2 in its region. 

3 (5) A school may not use individuals who are 

4 from low-income populations or minority groups, or 

5 who are women or confined in mental or penal insti6 tutions, as subjects for training or demonstration in 

7 numbers that are disproportionate to their numbers 

8 in the population of the region, and may not use any 

9 individuals as subjects for training or demonstration 

10 in a manner beyond that required for the immediate 

11 purpose of the training or demonstration or without 

12 their explicit consent. 

13 The National Health Board shall establish, not later than 

14 one year after the effective date of health services, guide15 lines for the application of these principles and for the 

16 phased integration of health worker education programs, 

17 including medical, dental, osteopathic, and nursing school 

18 programs, in existence on the date of enactment of this 

19 Act into the schools established under this section. 

20 (c) ADMISSIONS POLICIES.—Admissions policies for 

21 education programs in schools shall—

22 (1) emphasize previous health-related work ex23 perience, as evaluated by health workers (including 

24 peers), by individuals who have received health care 

25 services from the applicant, and by faculty members; 
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1 (2) minimize the use of criteria of academic 

2 performance other than such criteria as have been 

3 shown to be significantly related to future work per4 formance;

5 (3) give preference to segments of the popu6 lation of the region underrepresented among health 

7 workers; 

8 (4) to the extent consistent with paragraph (3), 

9 provide for admission of individuals so that the stu10 dent body approximates the population of the region 

11 by race, sex, family income, and language; and 

12 (5) require that the applicant agree, if accepted 

13 into the school, to perform health care services in ac14 cordance with section 312. 

15 (d) CURRICULUM POLICIES.—The National Health 

16 Board, in consultation with its local and regional authori17 ties, shall establish and implement curriculum policies for 

18 educational programs in schools. Such policies shall—

19 (1) give priority in study and field work to the 

20 leading causes of illness and death in the region, in21 cluding environmental, biological, and social deter22 minants of mortality and morbidity; 

23 (2) give special consideration to studying the 

24 social, as well as biological, causation and prevention 

25 of illness and disease, and to the differing health 
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1 care needs of populations facing special health risks 

2 and having special cultures and lifestyles within the 

3 region; 

4 (3) provide that all students shall take a com5 mon, initial sequence of courses and that students 

6 preparing for more advanced types of health work 

7 shall take studies that are progressively more spe8 cialized and differentiated; 

9 (4) emphasize work study experience in all 

10 types of health care facilities in the region, including 

11 community and workplace facilities, facilities for the 

12 aged, mentally ill, and mentally retarded, health care 

13 facilities in prisons and other correctional institu14 tions, alcohol and drug rehabilitation facilities, envi15 ronmental health facilities, and all other health care 

16 facilities of the Service in communities and districts 

17 in the region; 

18 (5) emphasize the appropriate and safe use, 

19 and discourage the overuse, of drugs and medical 

20 techniques; and 

21 (6) facilitate the development by all health 

22 workers of skills in decisionmaking and assessment 

23 of user needs in cooperation with other health work24 ers and with users. 
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1 (e) FACULTY HIRING PROCEDURES.—Faculty hiring 

2 procedures in schools shall, to the maximum extent fea3 sible, create a faculty which approximates the population 

4 of the region by race, sex, and language. 

5 (f) GOVERNANCE PLANS.—Governance plans for the 

6 management of a school shall give significant decision7 making powers to staff and students of the school. 

8 SEC. 312. SERVICE REQUIREMENT. 

9 (a) SERVICE REQUIREMENT.—

10 (1) IN GENERAL.—No individual may be en11 rolled in a school unless the individual agrees to per12 form health care services as an employee of the 

13 Service in the job category for which training is 

14 being provided—

15 (A) for a period of time equal to the period 

16 of such enrollment in the school but not less 

17 than 2 years; 

18 (B) beginning not later than 1 year after 

19 the date of the individual’s graduation from the 

20 school; and 

21 (C) for an area with the highest priority 

22 ranking under subsection (c) that agrees to em23 ploy the individual. 

24 (2) DEFERRAL.—An individual’s obligation to 

25 perform service under an agreement described in 
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1 paragraph (1) shall be deferred only for a period 

2 during which the individual is physically or mentally 

3 incapable of performing such service. 

4 (3) COMPLETION OF SERVICE REQUIRED.—No 

5 individual who has made an agreement described in 

6 paragraph (1) may be employed other than in ac7 cordance with subsection (c), until the individual has 

8 completed the period of obligated service in accord9 ance with this section. 

10 (4) PENALTY FOR BREACH OF AGREEMENT.—

11 Except as provided in paragraph (5), if an individual 

12 breaches an agreement under paragraph (1) by fail13 ing (for any reason) either to begin such individual’s 

14 service obligation or to complete such service obliga15 tion, the Service shall be entitled to recover from the 

16 individual an amount determined in accordance with 

17 the formula A=C (1–s / (t)) in which—

18 (A) ‘‘A’’ is the amount the Service is enti19 tled to recover; 

20 (B) ‘‘C’’ is an amount determined by the 

21 National Health Board to be the costs to the 

22 Service of the education program and allowance 

23 received by the individual and the interest on 

24 such costs which would be payable if at the 

25 time the costs were undertaken they were loans 
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1 bearing interest at the maximum legal pre2 vailing rate, as determined by the Treasurer of 

3 the United States; 

4 (C) ‘‘t’’ is the total number of months in 

5 the individual’s period of obligated service; and 

6 (D) ‘‘s’’ is the number of months of such 

7 period served by the individual. Any amount of 

8 damages which the Service is entitled to recover 

9 under this paragraph shall, within the 1-year 

10 period beginning on the date of the breach of 

11 the agreement, be paid to the Service. 

12 (5) CANCELLATION.—

13 (A) UPON DEATH.—Any obligation of an 

14 individual under this subsection for service or 

15 payment of damages shall be canceled upon the 

16 death of the individual. 

17 (B) EXTREME HARDSHIP EXCEPTION.—

18 The National Health Board shall provide for 

19 the waiver or suspension of any obligation of 

20 service or payment by an individual under this 

21 subtitle whenever compliance by the individual 

22 is impossible or would involve extreme hardship 

23 to the individual and if enforcement of such ob24 ligation with respect to any individual would be 

25 unconscionable. 
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1 (C) LIMITATION ON DISCHARGE IN BANK2 RUPTCY.—Any obligation of an individual under 

3 this subtitle for payment of damages may be re4 leased by a discharge in bankruptcy under title 

5 11 of the United States Code only if such dis6 charge is granted after the expiration of the 5-

7 year period beginning on the first date that 

8 payment of such damages is required. 

9 (b) PERIODIC REASSESSMENT OF WORKER RA10 TIOS.—The National Health Board shall periodically as11 sess the ratio of the number of health workers employed 

12 by the Board in each job category (established under sub13 title A) in an area to the number of residents in the area. 

14 (c) WORKER MATCHES.—The National Health Board 

15 shall establish a program to match the locational pref16 erences of graduates of schools with the needs and pref17 erences of regions. 

18 SEC. 313. PAYMENT FOR CERTAIN EDUCATIONAL LOANS. 

19 (a) LOAN PAYMENT PROGRAM.—In the case of any 

20 individual who has incurred any educational loan before 

21 the fourth year after the effective date of health services 

22 and for the individual’s costs for an educational program 

23 in health care delivery, health care specialties, or health 

24 science specialty fields, the National Health Board shall 

25 make payments, in accordance with subsection (b), for and 
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1 on behalf of that individual, on the principal of and inter2 est on any such loan which is outstanding on the date the 

3 individual begins to work for the Service. 

4 (b) MAKING OF PAYMENT.—The payments described 

5 in subsection (a) shall be made by the National Health 

6 Board as follows: 

7 (1) Upon completion by the individual for whom 

8 the payments are to be made of the first year of em9 ployment with the Service, the National Health 

10 Board shall pay 30 percent of the principal of, and 

11 the interest on, each loan described in subsection (a) 

12 which is outstanding on the date he began such em13 ployment. 

14 (2) Upon completion by that individual of the 

15 second year of such employment, the National 

16 Health Board shall pay another 30 percent of the 

17 principal of, and the interest on, each such loan. 

18 (3) Upon completion by that individual of a 

19 third year of such employment, the National Health 

20 Board shall pay another 25 percent of the principal 

21 of, and the interest on, each such loan. 

22 (4) Upon completion by that individual of a 

23 fourth year of such employment, the National 

24 Health Board shall pay the remaining 15 percent of 
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1 the principal of, and all remaining interest on, each 

2 such loan. 

3 No payment may be made under this subsection with re4 spect to a loan unless the person on whose behalf the pay5 ment is to be made has submitted to the National Health 

6 Board a certified copy of the agreement under which such 

7 loan was made. 

8 (c) PAYMENT DURING EMPLOYMENT.—Notwith9 standing the requirement of completion of employment 

10 specified in subsection (b), the National Health Board 

11 shall on or before the due date thereof, pay any loan or 

12 loan installment which may fall due within the period of 

13 employment for which the borrower may receive payments 

14 under this section, upon the declaration of such borrower, 

15 at such times and in such manner as the National Health 

16 Board may prescribe (and supported by such other evi17 dence as the National Health Board may reasonably re18 quire), that the borrower is then employed as described 

19 in subsection (b) and that the borrower will continue to 

20 be so engaged for the period required (in the absence of 

21 this subsection) to entitle the borrower to have made the 

22 payments provided by this section for such period, except 

23 that not more than 85 percent of the principal of any such 

24 loan shall be paid pursuant to this subsection. 
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1 Subtitle C—Employment and 

2 Labor-Management Relations 

3 Within the Service 

4 SEC. 321. EMPLOYMENT, TRANSFER, PROMOTION, AND RE5 CEIPT OF FEES. 

6 (a) SERVICE EMPLOYEES.—The National Health 

7 Board shall employ, classify, and fix the salaries and bene8 fits of all employees of the Service employed in the Serv9 ice’s facilities. 

10 (b) POLICIES.—The National Health Board, in estab11 lishing guidelines and standards under this subtitle, shall, 

12 to the extent feasible and consistent with the provisions 

13 of this subtitle, provide for—

14 (1) employment and promotion in the Service in 

15 the same manner as is provided for employment and 

16 promotion under the Federal civil service system; 

17 (2) meaningful opportunities for career ad18 vancement; 

19 (3) encouragement of health workers to use up 

20 to 10 percent of their work time for continuing edu21 cation under subtitle B without loss of pay or other 

22 job rights; and 

23 (4) full protection of employees’ rights by pro24 viding an opportunity for a fair hearing on adverse 

25 actions with representation of their own choosing. 
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1 (c) HIRING PREFERENCES.—The National Health 

2 Board, in hiring for employees to fill vacancies in newly 

3 created positions, shall give preference to individuals who 

4 were employed as health workers, or self-employed while 

5 delivering health services, before the date of enactment of 

6 this Act. The National Health Board shall ensure, through 

7 such steps as it deems necessary, that all such individuals 

8 desiring to be employed within the Service shall find ap9 propriate employment in the Service. 

10 (d) PROMOTION AND TRANSFER.—Employees of the 

11 Service shall be eligible for promotion or transfer to any 

12 position in the Service for which they are qualified. A job 

13 placement service in each region shall assist health work14 ers in its region in identifying suitable employment oppor15 tunities and in transferring between jobs. The authority 

16 given by this subsection shall be used to provide a max17 imum degree of career opportunities for employees and to 

18 ensure continued improvement of health care services. 

19 (e) NO UNDUE FINANCIAL INCENTIVES.—No health 

20 worker should benefit financially from the provision or de21 nial of services to individual patients, beyond their regular 

22 remuneration.

23 (f) SOLE EMPLOYER.—An employee of the Service 

24 may not receive any fee or perquisite on account of duties 
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1 performed by virtue of such employment except from the 

2 Service. 

3 (g) GRANDFATHER CLAUSE.—The National Health 

4 Board shall support alternative procedures to assure that 

5 health care professionals meet required standards, par6 ticularly those currently practicing in health professional 

7 shortage areas in inner cities and in rural communities. 

8 (h) TRANSITIONAL EMPLOYMENT.—Up to 1 percent 

9 of the budget of the United States Health Service for each 

10 of its first 2 years may be expended for the retraining 

11 and hiring of sales, administrative, clerical, and service 

12 employees displaced as a result of this Act, including those 

13 in the health insurance industry. 

14 SEC. 322. APPLICABILITY OF LAWS RELATING TO FEDERAL 

15 EMPLOYEES. 

16 (a) IN GENERAL.—Chapter 75 of title 5, United 

17 States Code (relating to adverse actions against employ18 ees), apply to employees of the Service (other than employ19 ees serving on the personal staff of members of health 

20 boards) except to the extent provided—

21 (1) in a collective bargaining agreement nego22 tiated on behalf of and applicable to them; or 

23 (2) in procedures established by the Service and 

24 approved by the Office of Personnel Management. 
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1 (b) COVERAGE UNDER WORKERS COMPENSATION.—

2 Employees of the Service are covered by subchapter I of 

3 chapter 81 of title 5, United States Code (relating to com4 pensation for work injuries). 

5 (c) CIVIL SERVICE.—

6 (1) APPLICATION OF CIVIL SERVICE RETIRE7 MENT.—Chapter 83 of title 5, United States Code 

8 (relating to civil service retirement), applies to em9 ployees of the Service except to the extent provided 

10 in a collective bargaining agreement negotiated on 

11 behalf of and applicable to them. 

12 (2) WITHHOLDING.—The Service shall withhold 

13 from pay and shall pay into the Civil Service Retire14 ment and Disability Fund the amounts specified in 

15 chapter 83 of title 5, United States Code, as re16 quired under paragraph (1). The Service, upon re17 quest of the Office of Personnel Management, but 

18 not less frequently than annually, shall pay to the 

19 Office the costs reasonably related to the adminis20 tration of Fund activities for employees of the Serv21 ice. 

22 (d) ACCRUAL OF SICK AND ANNUAL LEAVE.—Sick 

23 and annual leave and compensatory time of employees of 

24 the Service, whether accrued prior to or after the com-
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1 mencement of operations of the Service, shall be obliga2 tions of the Service. 

3 (e) APPLICATION OF CONDITIONS.—

4 (1) TERMS OF EMPLOYMENT.—Compensation, 

5 benefits, and other terms and conditions of employ6 ment in effect on the effective date of health services 

7 for employees of the Federal Government performing 

8 functions that are provided under this Act by the 

9 Service, shall apply to all employees of the Service 

10 performing similar functions until changed by the 

11 Service in accordance with this Act. Subject to the 

12 provisions of this Act, the provisions of subchapter 

13 I of chapter 85 and chapter 87 of title 5, United 

14 States Code (relating to unemployment compensa15 tion and life insurance), apply to employees of the 

16 Service unless varied, added to, or substituted for in 

17 accordance with paragraph (2). 

18 (2) LIMITATION ON VARIATION.—No variation, 

19 addition, or substitution with respect to fringe bene20 fits shall result in a program of fringe benefits which 

21 on the whole is less favorable to employees of the 

22 Service than fringe benefits in effect for employees 

23 of the Federal Government on the effective date of 

24 health services. No variation, addition, or substi25 tution with respect to fringe benefits of employees 
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1 for whom there is a collective bargaining representa2 tive shall be made except by agreement between such 

3 representative and the Service. 

4 SEC. 323. APPLICABILITY OF FEDERAL LABOR-MANAGE5 MENT RELATIONS LAWS. 

6 (a) APPLICATION OF NLRA.—

7 (1) IN GENERAL.—The provisions of the Na8 tional Labor Relations Act (42 U.S.C. 141 et seq.) 

9 shall apply to the Service and its employees to the 

10 extent, not inconsistent with subsection (b), to which 

11 such provisions apply to employers (as defined in 

12 section 2(2) of such Act), except that—

13 (A) the phrase ‘‘or any individual employed 

14 as a supervisor’’ in section 2(3) of such Act 

15 shall not apply (thereby making such Act apply, 

16 for these purposes, to such individuals); 

17 (B) section 9(b)(1) of such Act (providing 

18 for separate treatment for professional and 

19 nonprofessional employees) shall not apply; 

20 (C) sections 206 through 210 of such Act 

21 (relating to national emergencies) shall, for pur22 poses of this Act, have the phrases ‘‘the Presi23 dent of the United States’’ and ‘‘the Presi24 dent’’, wherever they appear, replaced by the 

25 phrase ‘‘the National Health Board (or a com-
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1 mittee thereof to which it has delegated such 

2 authority)’’ and the phrase ‘‘national health or 

3 safety’’ replaced by the phrase ‘‘health or safety 

4 of the residents of any region’’; and 

5 (D) section 213 (providing for intervention 

6 in a strike or lockout by the Director of the 

7 Federal Mediation and Conciliation Service) 

8 shall not apply. 

9 (2) STRIKES PERMITTED.—Paragraphs (3) and 

10 (4) of section 7311 of title 5, United States Code 

11 (prohibiting participation in a strike or an organiza12 tion asserting the right to strike), shall not apply to 

13 employees of the Service. 

14 (b) NEUTRALITY IN UNION MATTERS.—The Na15 tional Health Board shall adopt as a matter of general 

16 policy that governing boards at each level of the Service, 

17 and employers acting as agents of these boards, agree to 

18 determine employee preference on the subject of labor 

19 union representation, and to determine which one if union 

20 representation is preferred, by a card check procedure con21 ducted by a neutral third party in lieu of a formal election. 

22 (c) COLLECTIVE BARGAINING.—

23 (1) IN GENERAL.—Collective bargaining agree24 ments between the National Health Board and duly 

25 recognized bargaining representatives of employees 
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1 of the Service may include procedures for resolution 

2 by the parties of grievances and adverse actions aris3 ing under the agreement, including procedures cul4 minating in binding third party arbitration. 

5 (2) ALTERNATIVE PROCEDURES.—The National 

6 Health Board and duly recognized bargaining rep7 resentatives of employees of the Service may by mu8 tual agreement adopt procedures for the resolution 

9 by the parties—

10 (A) of grievances and adverse actions aris11 ing under collective bargaining agreements, and 

12 (B) of disputes or impasses arising in the 

13 negotiation of such agreements. 

14 (d) CONFORMING AMENDMENT.—Section 3(e) of the 

15 Labor-Management Reporting and Disclosure Act of 1959 

16 (42 U.S.C. 402(e)) is amended by inserting ‘‘the United 

17 States Health Service and’’ after ‘‘and includes’’. 

18 SEC. 324. DEFENSE OF CERTAIN MALPRACTICE AND NEG19 LIGENCE SUITS. 

20 (a) EXCLUSIVE REMEDY.—The remedy against the 

21 United States provided by sections 1346(b) and 2672 of 

22 title 28, United States Code, or by alternative benefits 

23 provided by the United States where the availability of 

24 such benefits precludes a remedy under section 1346(b) 

25 of such title, for damage for personal injury, including 
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1 death, resulting from the performance of medical, surgical, 

2 dental, or related functions, including the conduct of clin3 ical studies or investigations, by any employee of the Serv4 ice while acting within the scope of the employee’s employ5 ment, shall be exclusive of any other civil action or pro6 ceeding by reason of the same subject matter against the 

7 employee (or the employee’s estate) whose act or omission 

8 gave rise to the claim. 

9 (b) DEFENSE.—The Attorney General shall defend 

10 any civil action or proceeding brought in any court against 

11 any person referred to in subsection (a) (or the person’s 

12 estate) for any such damage or injury. Any such person 

13 against whom such civil action or proceeding is brought 

14 shall deliver within such time after date of service or 

15 knowledge of service as determined by the Attorney Gen16 eral, all process served upon the person or an attested true 

17 copy thereof to the person’s immediate superior or to 

18 whomever was designated by the appropriate National 

19 Health Board to receive such papers and such person shall 

20 promptly furnish copies of the pleading and process there21 in to the United States attorney for the district embracing 

22 the place wherein the proceeding is brought, to the Attor23 ney General, and to the National Health Board. 

24 (c) PROCEDURE.—
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1 (1) REMOVAL FROM STATE COURTS.—Upon a 

2 certification by the Attorney General that the de3 fendant was acting in the scope of employment at 

4 the time of the incident out of which the suit arose, 

5 any such civil action or proceeding commenced in a 

6 State court shall be removed without bond at any 

7 time before trial by the Attorney General to the dis8 trict court of the United States of the district and 

9 division embracing the place wherein it is pending 

10 and the proceeding deemed a tort action brought 

11 against the United States under the provision of 

12 title 28, United States Code, and all references 

13 thereto. 

14 (2) MOTIONS TO REMAND.—If a United States 

15 district court determines on a hearing on a motion 

16 to remand held before a trial on the merits that the 

17 case so removed is one in which a remedy by suit 

18 within the meaning of subsection (a) is not available 

19 against the United States, the case shall be re20 manded to the State court. 

21 (3) EFFECT OF ALTERNATIVE REMEDIES.—

22 Where a remedy by suit within the meaning of sub23 section (a) is not available because of the availability 

24 of a remedy through proceedings for compensation 

25 or other benefits from the United States as provided 
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1 by any other law, the case shall be dismissed, but in 

2 the event the running of any limitation of time for 

3 commencing, or filing an application or claim in, 

4 such proceedings for compensation or other benefits 

5 shall be deemed to have been suspended during the 

6 pendency of the civil action or proceeding under this 

7 section. 

8 (d) SETTLEMENT.—The Attorney General may com9 promise or settle any claim asserted in such civil action 

10 or proceeding in the manner provided in section 2677 of 

11 title 28, United States Code, and with the same effect. 

12 (e) LIMITATION.—For purposes of this section, the 

13 provisions of section 2680(h) of title 28, United States 

14 Code, shall not apply to assault or battery arising out of 

15 negligence in the performance of medical, surgical, dental, 

16 or related functions, including the conduct of clinical stud17 ies or investigations. 

18 (f) LIABILITY INSURANCE.—The appropriate Na19 tional Health Board may, to the extent it deems appro20 priate, hold harmless or provide liability insurance for any 

21 employee of the Service for damage for personal injury, 

22 including death, negligently caused by such employee while 

23 acting within the scope of employment and as a result of 

24 the performance of medical, surgical, dental, or related 

25 functions, including the conduct of clinical studies or in-
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1 vestigations, if the employee is assigned to a foreign coun2 try or detailed to a State or political subdivision thereof 

3 or to a nonprofit institution, and if the circumstances are 

4 such as are likely to preclude the remedies of third persons 

5 against the United States described in section 2679(b) of 

6 title 28, United States Code, for such damage or injury. 

7 TITLE IV—OTHER FUNCTIONS 

8 OF HEALTH BOARDS 

9 Subtitle A—Advocacy, Grievance 

10 Procedures, and Trusteeships 

11 SEC. 401. ADVOCACY AND LEGAL SERVICES PROGRAM. 

12 (a) ESTABLISHMENT OF PROGRAM.—The National 

13 Health Board shall establish a program of health advocacy 

14 to ensure the full realization of the patient rights enumer15 ated in subtitle A of title II. Such a program shall in16 clude—

17 (1) the employment of individuals having basic 

18 legal knowledge and skills as health advocates; 

19 (2) the presence of health advocates—

20 (A) in inpatient health care facilities at all 

21 times; and 

22 (B) in other health care facilities during 

23 the provision of health care services; 

24 (3) provision for health advocates to (A) in25 form, on an ongoing basis, users and health workers 
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1 of such patient rights and (B) report to the National 

2 Health Board any infraction of such rights which is 

3 not promptly corrected; 

4 (4) provision for regular meetings between 

5 health workers and health advocates, users, and any 

6 user representatives to discuss ways of ensuring the 

7 fulfillment of such rights through affirmative action 

8 of such workers and the National Health Board; and 

9 (5) appropriate action by the National Health 

10 Board to ensure that infractions of such rights are 

11 promptly and sufficiently corrected. 

12 (b) HEALTH RIGHTS LEGAL SERVICES.—

13 (1) ESTABLISHMENT OF PROGRAM.—The Na14 tional Health Board shall establish a health rights 

15 legal services program and shall provide such pro16 gram with sufficient legal and administrative per17 sonnel, funding, and facilities (A) to ensure that 

18 users and health workers receive, free of charge, 

19 high quality legal services (including representation 

20 in grievance proceedings commenced under section 

21 402) for legal problems related to health rights and 

22 health care services, and (B) to improve, through 

23 litigation and other activities, the health care system 

24 and expand the rights of users and health workers. 
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1 (2) SERVICES.—The health rights legal services 

2 program shall provide directly, by contract with the 

3 Legal Services Corporation, or by contract with 

4 members of the private bar, for—

5 (A) establishment of a legal services office 

6 in each region to provide representation (other 

7 than representation provided under subpara8 graph (B)) of users, health workers, and vol9 untary associations having a demonstrated in10 terest in health care in proceedings and hear11 ings under sections 324 and 402; and 

12 (B) establishment of legal services offices 

13 in such communities and districts as are deter14 mined, in accordance with guidelines established 

15 by the National Health Board, to have inad16 equate legal services to provide the legal serv17 ices described in paragraph (1)(A). 

18 (3) USE OF CONTRACTS.—The National Health 

19 Board may carry out the functions described in 

20 paragraph (1)(B) directly, by contract, or otherwise. 

21 SEC. 402. GRIEVANCE PROCEDURES. 

22 (a) GRIEVANCE PROCEEDINGS.—

23 (1) IN GENERAL.—The National Health Board 

24 shall provide, in accordance with this section, that 

25 any user, health worker, or any user association hav-
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1 ing a demonstrated interest in health care may com2 mence a grievance proceeding before the Board (or 

3 a person or committee designated by such Board) 

4 with respect to an alleged violation of this Act. The 

5 National Health Board may commence a grievance 

6 proceeding before itself (or a person or committee 

7 designated by such Board) with respect to an alleged 

8 violation of this Act. 

9 (2) GRIEVANCES AGAINST NATIONAL HEALTH

10 BOARD.—Grievances against the National Health 

11 Board may be presented to and adjudicated by the 

12 Inspector General for Health Services or the Inspec13 tor’s General local designees. Grievants shall also 

14 have access to review in the courts. 

15 (b) REVIEW.—

16 (1) BY NATIONAL HEALTH BOARD.—The Na17 tional Health Board shall provide, subject to para18 graphs (2) and (3), for its review (or a review by a 

19 person or committee designated by the Board), by 

20 appeal to the Board by any party to a proceeding 

21 described in subsection (a)(1) or on its own initia22 tive, of an adverse decision 

23 (2) LIMITATION ONCE SUIT COMMENCED.—On 

24 and after the date a suit with respect to an adverse 

25 determination in a grievance proceeding or review 
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1 proceeding is filed under subsection (e), no review 

2 proceeding respecting such proceeding may be com3 menced by appeal to the Board under paragraph (1), 

4 and any such review proceeding which was com5 menced by appeal to the Board under such para6 graph before the date of filing of such suit and is 

7 pending on such date shall promptly be discon8 tinued. 

9 (3) TIME LIMIT.—No review of an adverse ad10 ministrative decision may be made by appeal or by 

11 initiative under this subsection unless the appeal is 

12 filed or notice of the initiative is published (as the 

13 case may be) not later than 30 days after the publi14 cation of the decision. 

15 (c) INVESTIGATION.—Whenever a grievance pro16 ceeding is commenced under subsection (a), the entity be17 fore which the proceeding is held shall investigate the 

18 grievance. 

19 (d) RIGHT TO SUE.—Any party to a grievance pro20 ceeding or review proceeding commenced under this sec21 tion may bring suit in the United States district court for 

22 the judicial district in which such proceeding, or review 

23 proceeding, was brought, for the review of an adverse de24 termination in such proceeding or review proceeding. Such 

25 court shall affirm such determination unless it finds that 
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1 such determination is not supported by substantial evi2 dence or is arbitrary and capricious. 

3 Subtitle B—Occupational Safety 

4 and Health Programs 

5 SEC. 411. FUNCTIONS OF THE NATIONAL HEALTH BOARD. 

6 (a) OVERSIGHT AUTHORITY.—On and after the effec7 tive date of health services, the National Health Board 

8 shall oversee occupational safety and health programs con9 ducted at the regional level, and shall participate in the 

10 establishment and administration of occupational safety 

11 and health standards under the Occupational Safety and 

12 Health Act of 1970. 

13 (b) CONFORMING AMENDMENTS.—

14 (1) IN GENERAL.—To provide for participation 

15 of the National Health Board in the establishment 

16 and administration of occupational safety and health 

17 standards, the Occupational Safety and Health Act 

18 of 1970 (29 U.S.C. 651 et seq.) is amended—

19 (A) in section 3, by adding at the end the 

20 following new paragraph: 

21 ‘‘(15) The term ‘National Health Board’ means 

22 the National Health Board of the United States 

23 Health Services.’’; 

24 (B) by striking ‘‘Secretary of Health and 

25 Human Services’’ each place it appears (other 
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1 than in section 22(b)) and inserting ‘‘National 

2 Health Board’’; 

3 (C) in the first sentence of section 6(b)(1), 

4 by inserting ‘‘shall request the National Health 

5 Board and’’ before ‘‘may request’’; 

6 (D) in the second sentence of section 

7 6(b)(1), by inserting ‘‘the Board and’’ after 

8 ‘‘The Secretary shall provide’’; 

9 (E) in the third sentence of section 

10 6(b)(1), by striking ‘‘An’’ and inserting ‘‘The 

11 Board and an’’; 

12 (F) in the third sentence of section 

13 6(b)(1), by striking ‘‘its’’ each place it appears 

14 and inserting ‘‘their’’; 

15 (G) in the fourth sentence of section 

16 6(b)(6)(A), by inserting ‘‘after consultation 

17 with the National Health Board and’’ after 

18 ‘‘may be granted only’’; 

19 (H) in the third sentence of section 6(d), 

20 by inserting ‘‘after consultation with the Na21 tional Health Board and’’ before ‘‘after oppor22 tunity for’’; 

23 (I) in section 8(g)(2), by striking ‘‘The 

24 Secretary’’ and all that follows through ‘‘shall 

25 each’’ and inserting ‘‘The Secretary shall’’;
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1 (J) in section 8(g)(2), by striking ‘‘their’’ 

2 and inserting ‘‘his’’; 

3 (K) in section 16, by inserting ‘‘after con4 sultation with the National Health Board and’’ 

5 before ‘‘after notice and opportunity’’; 

6 (L) in section 18(c), by inserting ‘‘(after 

7 consultation with the National Health Board)’’ 

8 after ‘‘in his judgment’’; 

9 (M) in section 19(d), by inserting ‘‘and the 

10 National Health Board’’ after ‘‘Secretary’’ each 

11 place it appears; and 

12 (N) in section 20(a), by striking the first 

13 sentence of paragraph (5). 

14 (2) EFFECTIVE DATE.—The amendments made 

15 by paragraph (1) shall take effect on the effective 

16 date of health services. 

17 (f) GUIDELINES.—The National Health Board shall 

18 establish guidelines—

19 (1) for its participation in the establishment 

20 and administration of occupational safety and health 

21 standards under the Occupational Safety and Health 

22 Act of 1970; and 

23 (2) for the establishment and operation of 

24 workplace health facilities under section 413. 
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1 SEC. 412. COMMUNITY OCCUPATIONAL SAFETY AND 

2 HEALTH ACTIVITIES. 

3 The Occupational Safety and Health Administration, 

4 under the direction of the National Health Board, shall 

5 develop and provide staff support for local and regional 

6 occupational safety and health programs, to include com7 munity-based occupational safety and health councils that 

8 represent community workers and residents. Such pro9 grams shall—

10 (1) promote and assist in the establishment of 

11 workplace occupational safety and health committees 

12 in workplaces in the community, and advise and fa13 cilitate such committees’ actions relating to safety 

14 and health hazards in workplaces in the community; 

15 and 

16 (2) assist employees in determining methods of, 

17 and requirements for, inspections of workplaces in 

18 the community for safety and health hazards. 

19 (3) implement training programs to en20 hance the ability of employees in the region to 

21 monitor safety and health conditions in their 

22 workplaces and to assist safety and health in23 spectors in the conduct of workplace inspec24 tions; 

25 (4) facilitate communication among work26 ers employed in similar industries in the region 
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1 and the Nation with respect to occupational 

2 health and safety hazards they face in common; 

3 (5) conduct baseline and periodic biologic 

4 screening of employees in the region; 

5 (6) develop and maintain environmental 

6 monitoring programs to identify and isolate 

7 hazardous workplaces and work areas in the re8 gion; 

9 (7) analyze employment-related injuries 

10 and illnesses occurring in the region 

11 SEC. 413. WORKPLACE HEALTH FACILITIES. 

12 (a) ESTABLISHMENT.—The Occupational Safety and 

13 Health Administration, under the direction of the Na14 tional Health Board, shall develop a program to establish 

15 worksite health facilities, distributed to make available oc16 cupational and emergency health care services to individ17 uals employed in the workplace in accordance with this 

18 section and guidelines and standards for such facilities es19 tablished by the National Health Board. Such facilities 

20 may be maintained by each employer where the facility 

21 is located, or by the group of employers covered by a facil22 ity. 

23 (b) APPLICATION OF GUIDELINES.—Each workplace 

24 health facility established pursuant to subsection (a) shall, 
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1 taking into account guidelines established by the National 

2 Health Board—

3 (1) be organized in a manner so as to provide 

4 an appropriate number of appropriately skilled 

5 health workers to meet occupational and emergency 

6 health care needs of employees in the workplace; and 

7 (2) be operated by the community for the com8 munity in which the workplace is predominantly lo9 cated, or, where the National Health Board or its 

10 local authority deems appropriate, by the employer, 

11 with the cost in either case borne by the employer 

12 in each workplace. 

13 SEC. 414. EMPLOYEE RIGHTS RELATING TO OCCUPATIONAL 

14 SAFETY AND HEALTH. 

15 (a) WORKPLACE COMMITTEES.—

16 (1) ESTABLISHMENT.—Employees in each 

17 workplace having 25 or more employees shall have 

18 the right to establish workplace occupational safety 

19 and health committees (each in this subsection re20 ferred to as a ‘‘committee’’) with members of their 

21 choosing. 

22 (2) MEMBERSHIP.—Members of committees 

23 (composed of the greater of 3 members or one mem24 ber for each 100 employees in the workplace) shall, 

25 without any loss of pay or other job rights—
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1 (A) be permitted to spend eight hours of 

2 each month inspecting their workplace and con3 ducting such other functions relating to occupa4 tional safety and health as are determined by 

5 the employees in the workplace; and 

6 (B) be permitted to accompany any safety 

7 and health inspectors during inspections of the 

8 workplace. 

9 (b) SAFETY-RELATED RIGHTS.—Employees in each 

10 workplace shall have the right, without any loss of pay 

11 or other job rights—

12 (1) to monitor safety and health conditions in 

13 their workplace whenever they reasonably deem it 

14 necessary and with whatever reasonable scientific in15 struments and expert assistance they choose; and 

16 (2) to remove themselves from the site of any 

17 hazard to their safety or health until an authorized 

18 inspector has certified that the hazard has been 

19 eliminated.

20 (c) SAFE WORKPLACES.—Employers shall adopt all 

21 feasible engineering measures that will minimize occupa22 tional safety and health hazards in the workplace. Where 

23 such measures are not adequate to protect employees from 

24 such hazards, employers shall furnish their employees 

25 with, or reimburse their employees for the reasonable cost 
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1 of, equipment and clothing needed to protect an employee 

2 from any residual occupational safety and health hazards 

3 in the workplace. 

4 (d) RIGHT TO INSPECT MEDICAL RECORDS.—Em5 ployees or their duly chosen representatives shall have the 

6 right to inspect all medical records maintained by their 

7 employers on the condition of their health, and shall have 

8 the right to be assisted during such inspections by persons 

9 of their choosing. 

10 (e) COPIES OF REPORTS.—Employers shall provide 

11 their employees with copies of all reports, studies, and 

12 data concerning conditions affecting the health and safety 

13 of employees within their workplaces, with annual reports 

14 on the morbidity and mortality experience of present and 

15 former employees, and with timely notification of the pres16 ence within the workplace of any materials, agents, or con17 ditions which may have a deleterious effect on the safety 

18 and health of their employees, along with relevant infor19 mation on hazards and precautions, symptoms, remedies, 

20 and antidotes. 

21 (f) RIGHT TO NEGOTIATE STANDARDS.—Employees 

22 shall have the right to seek, through collective bargaining, 

23 occupational safety and health standards, including stand24 ards relating to physical and mental stress and speed of 
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1 work, more restrictive than such standards established 

2 under the Occupational Safety and Health Act of 1970. 

3 SEC. 415. DEFINITIONS. 

4 (a) WORKPLACE.—For purposes of this subtitle, the 

5 term ‘‘workplace’’ means the regular location where work 

6 is performed by one or more employees of an employer. 

7 (b) EMPLOYER; EMPLOYEE.—For the purposes of 

8 sections 413 and 414, the terms ‘‘employer’’ and ‘‘em9 ployee’’ have the same meanings those terms have in sec10 tion 3 of the Occupational Safety and Health Act of 1970 

11 (42 U.S.C. 653). 

12 Subtitle C—Health and Health 

13 Care Delivery Research, Quality 

14 Assurance, and Health Equity 

15 SEC. 421. PRINCIPLES AND GUIDELINES FOR RESEARCH. 

16 (a) CONDUCT.—On and after the effective date of 

17 health services, the Service shall conduct a program of re18 search concerning health and health care delivery. On and 

19 after 2 years after such date, such research program shall 

20 conform to the following principles: 

21 (1) The research shall, to the maximum extent 

22 possible, be performed under the direction of, and in 

23 association with, agencies representative of the popu24 lation. 
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1 (2) No research shall be conducted within, or 

2 using the resources of, an area health facility until 

3 it has been reviewed and approved by the National 

4 Health Board, or a designated local authority re5 sponsible for such facility. 

6 (3) Priority shall be given in health research to 

7 the prevention and correction of the leading causes 

8 of illness and death, particularly environmental, oc9 cupational, nutritional, social, and economic causes. 

10 (4) Priority shall be given in health care deliv11 ery research to improvement of the effectiveness and 

12 efficiency of ambulatory and primary health care de13 livery, including research on alternative systems of 

14 health care delivery and alternative conceptions of 

15 health and health care. 

16 (5) The National Health Board shall encourage 

17 and support the conduct of clinical trials that may 

18 improve the health of the public. Any clinical trial 

19 conducted with the intention of evaluating new pre20 ventive, diagnostic, or therapeutic methods or agents 

21 shall be conducted only in accordance with estab22 lished ethical procedures that protect subjects from 

23 undue harm. If benefit becomes apparent, by sci24 entific consensus, before the scheduled conclusion of 

25 any clinical trial, such trial shall nevertheless be ter-
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1 minated, and the benefit made available to trial par2 ticipants and the public at large. 

3 (6) No research shall be conducted on a human 

4 subject without the subject’s informed written con5 sent. 

6 (7) No research shall be conducted on a human 

7 subject while the subject is involuntarily confined to 

8 an institution. 

9 (8) The planning and conduct of research under 

10 the program, shall take place in cooperation with ap11 propriate officials conducting related research in the 

12 Federal Government and agencies and departments 

13 of State, territorial, and local governments. 

14 (9) The results of research shall be dissemi15 nated to the public and to National Health Board in 

16 a manner that will most readily permit the use of 

17 such results to improve the health of users and the 

18 delivery of health care services. 

19 (b) GUIDELINES.—The National Health Board shall 

20 establish guidelines for the conduct of research in con21 formance with the principles described in subsection (a). 

22 SEC. 422. ESTABLISHMENT OF INSTITUTES. 

23 (a) IN GENERAL.—On the effective date of health 

24 services, the agencies of the Department of Health and 

25 Human Services that conduct research on health and 
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1 health care are transferred to the National Health Board. 

2 These include the Agency for Healthcare Research and 

3 Quality, the Agency for Toxic Substances and Disease 

4 Registry, the Centers for Disease Control and Prevention, 

5 the National Institutes of Health (established under title 

6 IV of the Public Health Service Act), and the Substance 

7 Abuse and Mental Health Services Administration. In ad8 dition, the National Health Board shall establish the fol9 lowing institutes: 

10 (1) NATIONAL INSTITUTE OF EPIDEMIOLOGY.—

11 A National Institute of Epidemiology, which shall—

12 (A) gather and analyze disease-related sta13 tistics collected by the Service; 

14 (B) plan, conduct, support, and assist in 

15 epidemiologic research conducted by the Serv16 ice;

17 (C) conduct and support research on epi18 demiologic methodology and experimental epide19 miology; 

20 (D) establish and maintain an early warn21 ing system for the detection of new diseases 

22 and epidemics; 

23 (E) assist in the formulation of policies to 

24 eliminate or reduce the causes of illness and in-
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1 jury and to prevent and curtail epidemics of 

2 these conditions; and 

3 (F) provide technical assistance and sup4 port to regional and local jurisdictions related 

5 to measures to prevent and curtail outbreaks of 

6 illness and injury. 

7 (2) NATIONAL INSTITUTE OF EVALUATIVE

8 CLINICAL RESEARCH.—A National Institute of Eval9 uative Clinical Research, which shall—

10 (A) create a uniform electronic data base 

11 for research on quality improvement in clinical 

12 care and the organization and delivery of serv13 ices, and for research on outcomes of care; 

14 (B) assess and analyze evidence on newly 

15 discovered or proposed preventive, diagnostic, 

16 and therapeutic methods and agents, including 

17 new technologies, and assist the National 

18 Health Board, in cooperation with other bodies, 

19 including the National Institute of Pharmacy 

20 and Medical Supply, in developing guidelines 

21 and standards for their introduction; 

22 (C) analyze evidence on newly discovered 

23 or proposed preventive, diagnostic, and thera24 peutic methods and agents; 
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1 (D) plan and conduct clinical trials, in con2 formance with the limitations of subtitle A of 

3 title II; 

4 (E) assist the National Health Board, in 

5 cooperation with other bodies, including the Na6 tional Institute of Pharmacy and Medical Sup7 ply, in developing guidelines and standards for 

8 the introduction of new methods of prevention, 

9 diagnosis, and treatment; 

10 (F)(i) regularly assess and recommend 

11 measures to improve the health status of the 

12 population, which methods shall include anal13 ysis of the national health data base, regular 

14 surveys of the population regarding their expe15 rience and evaluation of their health and health 

16 services, and such other methods as designated 

17 by the Institute; 

18 (ii) identify the most effective methods of 

19 prevention, diagnosis and treatment, as deter20 mined by the most recent evidence, and assist 

21 the National Health Board, in cooperation with 

22 other bodies, in establishing guidelines to im23 prove clinical practice, including clinical deci24 sion criteria per section 221(f); 
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1 (iii) regularly monitor and report to the 

2 National Health Board for further action the 

3 extent of inappropriate care, including under4 service and overservice, and its consequences; 

5 (iv) develop additional methods of quality 

6 improvement for implementation by the Na7 tional Health Board and other entities, includ8 ing systematic review of patterns of practice 

9 that compromise the quality of care and rec10 ommendations to redress such practices, edu11 cation for health care workers to improve the 

12 quality of care, and guidelines for the optimal 

13 organization of health services and the use of 

14 tertiary care facilities; 

15 (G) administer the periodic convening of 

16 the U.S. Preventive Health Services Task 

17 Force, which shall recommend to the National 

18 Health Board a schedule for preventive health 

19 services based on age and sex, which schedule 

20 shall reflect the most recent medical evidence; 

21 and 

22 (H) provide education for users on clinical 

23 effectiveness guidelines and the most effective 

24 preventive, diagnostic, and treatment practices. 
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1 (3) NATIONAL INSTITUTE OF HEALTH CARE

2 SERVICES.—A National Institute of Health Care 

3 Services, which shall—

4 (A) analyze data and statistics on the 

5 health care resources and needs of the Nation 

6 and on the quality of present services; 

7 (B) conduct comparative studies of health 

8 care services in the various regions of the Na9 tion, and make recommendations for the im10 provement of health care services in areas with 

11 inferior quality of health care services; 

12 (C) plan and conduct research on alter13 native methods of health care delivery, on the 

14 functions, tasks, performance and work rela15 tionships of various kinds and categories of 

16 health workers, on patterns of organization of 

17 health care, and on the effectiveness and bene18 fits of health care in relation to costs; and 

19 (D) assist the National Health Board in 

20 formulating national policies to improve the 

21 quality of health care services. 

22 (4) NATIONAL INSTITUTE OF PHARMACY AND

23 MEDICAL SUPPLY.—A National Institute of Phar24 macy and Medical Supply, which shall—
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1 (A) recommend to the National Health 

2 Board standards regarding the quality, dis3 tribution, and price of all drugs, therapeutic de4 vices, appliances and equipment to be used by 

5 the Service; 

6 (B) certify drugs, therapeutic devices, ap7 pliances, and equipment for use in the health 

8 facilities of the Service, and for furnishing to 

9 users of such health facilities; 

10 (C) assist the National Health Board in 

11 issuing a National Pharmacy and Medical Sup12 ply Formulary; and 

13 (D) conduct a comprehensive program of 

14 pharmaceutical and medical supply research 

15 and utilization education using regional facili16 ties to the maximum extent possible.

17 (5) NATIONAL INSTITUTE OF SOCIOLOGY OF

18 HEALTH AND HEALTH CARE.—A National Institute 

19 of Sociology of Health and Health Care, which 

20 shall—

21 (A) conduct ongoing analyses of the basic 

22 epistemological assumptions of health and 

23 health care; 
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1 (B) assess critically the effects of scientific 

2 medicine and of divisions in institutional and 

3 technical skills in health care; 

4 (C) evaluate the effects of health care 

5 measures and policies upon population groups 

6 and subgroups in the Nation; 

7 (D) identify and analyze the social, cul8 tural, economic, occupational, distributional, 

9 and environmental factors in modern society af10 fecting health and well-being; 

11 (E) analyze alternative, holistic approaches 

12 to the human body, health, and causality of ill 

13 health and the lack of social and psychological 

14 well-being; and 

15 (F) assist the National Health Board in 

16 formulating national policies relating to the pro17 motion of health and the provision of health 

18 care. 

19 (b) COORDINATION OF EFFORT.—The National 

20 Health Board will establish mechanisms for internal co21 ordination of research among the five Institutes, and will 

22 also coordinate effort with agencies under the Department 

23 of Health and Human Services, including the Food and 

24 Drug Administration and the Health Resources and Serv25 ices Administration. 
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1 Subtitle D—Health Planning, Dis2 tribution of Drugs and Other 

3 Medical Supplies, and Miscella4 neous Functions 

5 SEC. 431. HEALTH PLANNING AND BUDGETING. 

6 (a) IN GENERAL.—The National Health Board shall 

7 develop and implement guidelines to collect data on the 

8 supply of and demand for health workers in facilities 

9 under its supervision, and on the delivery of health care 

10 and supplemental services in health care facilities under 

11 its supervision, shall evaluate such data in relation to the 

12 health care needs of their respective area, and shall trans13 mit such data and evaluation as necessary for implementa14 tion, and shall make available such data and evaluations 

15 to residents of their respective area. 

16 (b) COORDINATION.—The National Health Board 

17 shall coordinate the planning and administration of the 

18 delivery of health care services, health worker education, 

19 and health research within regions, and shall facilitate the 

20 planning and administration of such programs. 

21 (c) PLANS.—The National Health Board shall formu22 late a 1-year and 5-year national health plan and budget, 

23 taking into account the regional budgets prepared in ac24 cordance with section 522. 
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1 SEC. 432. DISTRIBUTION OF DRUGS AND OTHER MEDICAL 

2 SUPPLIES. 

3 (a) NATIONAL FORMULARY.—

4 (1) PUBLICATION.—The National Health 

5 Board, shall, not later than the effective date of 

6 health services, publish and disseminate a National 

7 Pharmacy and Medical Supply Formulary (in this 

8 section referred to as the ‘‘Formulary’’). 

9 (2) CONTENTS.—The Formulary shall contain a 

10 listing of drugs, therapeutic devices, appliances, 

11 equipment, and other medical supplies (including 

12 eyeglasses, other visual aids, hearing aids, and pros13 thetic devices) (in this section referred to as ‘‘drugs 

14 and other medical supplies’’). For each item on such 

15 listing the Formulary shall contain (A) the stand16 ards of quality for the production of such item, (B) 

17 the medical conditions for which the item is certified 

18 as effective for purposes of the provision of health 

19 care services under this Act, and (C) such other in20 formation on such item as the National Health 

21 Board determines to be appropriate for the effective 

22 and efficient delivery of health care services under 

23 this Act. 

24 (3) UPDATING.—The National Health Board 

25 shall, at regular intervals, update the contents of the 

26 Formulary and publish a price list for items listed 
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1 in the Formulary, which prices shall reflect the ac2 tual costs of manufacture. 

3 (b) DRUG PURCHASE PROGRAMS.—

4 (1) IN GENERAL.—The National Health Board 

5 shall establish a program, in accordance with this 

6 subsection for the purchase and distribution of 

7 drugs and other medical supplies for use in health 

8 care facilities. 

9 (2) PRICING.—Such program shall provide for 

10 the purchase of each drug or other medical supply 

11 item only (A) following competitive bidding on such 

12 item or (B) based on the price listed for such item 

13 in the price list published under subsection (a)(3). 

14 (3) GENERIC DISTRIBUTION.—Such program 

15 shall provide for the distribution and dispensing of 

16 drugs under their generic names. 

17 (4) GENERIC NAMES DEFINED.—For purposes 

18 of paragraph (3), the term ‘‘generic names’’ means 

19 the established names, as defined in section 

20 502(e)(2) of the Federal Food, Drug, and Cosmetic 

21 Act (21 U.S.C. 352(e)(2)). 

22 (c) AUTHORITY TO MANUFACTURE.—The National 

23 Health Board is authorized to establish and operate drug 

24 and medical supply manufacturing facilities, if it deter-
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1 mines that such operation will result in reduced expendi2 tures by the Service. 

3 SEC. 433. MISCELLANEOUS FUNCTIONS OF THE NATIONAL 

4 HEALTH BOARD. 

5 (a) ANNUAL REPORT.—The appropriate National 

6 Health Board shall publish, not later than December 31 

7 of each year, a report presenting and evaluating oper8 ations of the Service during the fiscal year ending in such 

9 year and surveying the future health needs of the Nation 

10 and plans the Board has for the Service to meet such 

11 needs. 

12 (b) DISSEMINATION.—The National Health Board 

13 shall, not later than the effective date of health services, 

14 prepare and disseminate, for use by users, information 

15 about health and health services deemed essential to en16 sure users’ active and informed participation in the health 

17 care system, including information that is culturally ap18 propriate for each area’s principal cultural and ethnic 

19 groupings, a comprehensive dictionary of terms used in 

20 health care records and services maintained or provided 

21 by the Service. Such dictionary shall explain terms related 

22 to symptoms, signs, diagnoses, etiologic agents and condi23 tions, diagnostic procedures, and the treatment and pre24 vention of, and rehabilitation following, illnesses, and shall 

25 include extensive citations of lay and professional sources 
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1 which a user might consult for additional information on 

2 such terms. 

3 TITLE V—FINANCING OF THE 

4 SERVICE 

5 Subtitle A—Health Service Taxes 

6 SEC. 501. INDIVIDUAL AND CORPORATE INCOME TAXES. 

7 (a) HEALTH SERVICE TAXES.—

8 (1) IN GENERAL.—Subchapter A of chapter 1 

9 of the Internal Revenue Code of 1986 (relating to 

10 normal taxes and surtaxes) is amended by adding at 

11 the end the following new part: 

12 ‘‘PART VIII—HEALTH SERVICE TAXES

‘‘Sec. 59B. Tax imposed.

13 ‘‘SEC. 59B. TAX IMPOSED. 

14 ‘‘(a) INDIVIDUALS, ESTATES, AND TRUSTS.—In ad15 dition to other taxes, there is hereby imposed for each tax16 able year on the taxable income of every individual and 

17 of every estate and trust taxable under section 1(d), a tax 

18 in an amount equal to 10 percent of the total tax imposed 

19 by section 1 for such taxable year. 

20 ‘‘(b) CORPORATION.—In addition to the other taxes, 

21 there is hereby imposed for each taxable year on the tax22 able income of every corporation, a tax in an amount equal 

23 to 90 percent of the total amount of the normal tax and 

24 surtax imposed by section 11 for such taxable year.’’
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1 (2) CLERICAL AMENDMENT.—The table of 

2 parts of such subchapter A is amended by adding 

3 after the item relating to part VII the following new 

4 item:

‘‘Part VIII. Health service taxes.’’.

5 (b) EFFECTIVE DATE.—The amendments made in 

6 this section shall apply to taxable years beginning on or 

7 after the effective date of health services.

8 SEC. 502. OTHER CHANGES IN THE INTERNAL REVENUE 

9 CODE OF 1986. 

10 (a) DENIAL OF EXCLUSION FROM GROSS INCOME

11 FOR AMOUNTS PAID BY THIRD PARTIES FOR MEDICAL

12 CARE.—Section 105 of the Internal Revenue Code of 1986 

13 (relating to amounts received under accident and health 

14 plans) is amended by striking subsection (b). 

15 (b) DENIAL OF EXCLUSION FROM GROSS INCOME OF

16 CERTAIN CONTRIBUTIONS BY THE EMPLOYER TO

17 HEALTH PLANS.—Subsection (a) of section 106 of such 

18 Code (relating to contributions by employer to accident 

19 and health plans) is amended to read as follows: 

20 ‘‘(a) GENERAL RULE.—Except as otherwise provided 

21 in this section, gross income does not include contributions 

22 by the employer to accident or health plans for compensa23 tion (through insurance or otherwise) to his employees for 

24 personal injuries or sickness to the extent that such con25 tributions do not provide for health care and supplemental 
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1 services available to such employees under the Josephine 

2 Butler United States Health Service Act.’’

3 (c) DENIAL OF DEDUCTION OF HEALTH CARE EX4 PENSES AS TRADE OR BUSINESS EXPENSES.—Section 

5 162 of such Code (relating to trade or business expenses) 

6 is amended by redesignating subsection (p) as subsection 

7 (q) and by adding after subsection (o) the following new 

8 subsection: 

9 ‘‘(p) PAYMENTS FOR HEALTH CARE.—No deduction 

10 shall be allowed under subsection (a) for any amount paid 

11 for health care services (other than any amount of tax im12 posed by section 59B and paid by the employer on behalf 

13 of his employees) which an individual was eligible to re14 ceive under title II of the Josephine Butler United States 

15 Health Service Act.’’. 

16 (d) DENIAL OF DEDUCTION FOR CONTRIBUTIONS TO

17 CERTAIN MEDICAL AND HOSPITAL FACILITIES.—

18 (1) Paragraph (2) of section 170(c) of such 

19 Code (relating to charitable, etc., contributions and 

20 gifts) is amended by inserting ‘‘(other than an orga21 nization described in subsection (b)(1)(A)(iii))’’ after 

22 ‘‘(2) A corporation, trust, or community chest, fund, 

23 or foundation’’. 
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1 (2) Subsection (e) of section 501 of such Code 

2 (relating to cooperative hospital service organiza3 tions) is amended by striking the last sentence. 

4 (e) DENIAL OF DEDUCTION FOR MEDICAL, DENTAL, 

5 ETC., EXPENSES.—

6 (1) Section 213 of such Code (relating to med7 ical, dental, etc., expenses) is repealed. 

8 (2) The table of sections of part VII of sub9 chapter B of chapter 1 of such Code is amended by 

10 striking the item relating to section 213. 

11 (f) HOSPITAL INSURANCE TAX.—

12 (1) Subsection (b) of section 1401 of such Code 

13 (relating to rate of tax on self-employment income) 

14 is repealed. 

15 (2) Subsection (b) of section 3101 of such Code 

16 (relating to rate of tax on employees under the Fed17 eral Insurance Contributions Act) is repealed. 

18 (3) Section 3201(a) of such Code (relating to 

19 rate of tax imposed on employees under the Railroad 

20 Retirement Tax Act) is amended by striking ‘‘the 

21 sum of the rates of tax in effect under subsections 

22 (a) and (b) of section 3101’’ and inserting ‘‘the rate 

23 of tax in effect under section 3101(a)’’. 

24 (4) Section 3211(a)(1) of such Code (relating 

25 to rate of tax on employee representatives under the 
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1 Railroad Retirement Tax Act) is amended by strik2 ing ‘‘subsections (a) and (b)’’ the first place it ap3 pears and inserting ‘‘subsection (a)’’. 

4 (5) Subsection (e) of section 6051 of such Code 

5 (relating to railroad employees) is repealed. 

6 (g) EFFECTIVE DATE.—The amendments made by 

7 this section shall apply to taxable years beginning on or 

8 after the effective date of health services. 

9 SEC. 503. EXISTING EMPLOYER-EMPLOYEE HEALTH BEN10 EFIT PLANS. 

11 No contractual or other nonstatutory obligation of 

12 any employer to pay for or provide any health care and 

13 supplemental service to his present and former employees 

14 and their dependents and survivors, or to any of such per15 sons, shall apply on and after the effective date of health 

16 services to the extent such individuals are eligible to re17 ceive such health care and supplemental services under 

18 this Act. 

19 SEC. 504. WORKERS COMPENSATION PROGRAMS. 

20 No workers compensation program, whether estab21 lished pursuant to Federal or State law or private initia22 tive, shall pay for or provide any health care and supple23 mental services on and after the effective date of health 

24 services, to the extent such health care and supplemental 

25 services are available under this Act. 
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1 Subtitle B—Health Service Trust 

2 Fund 

3 SEC. 511. ESTABLISHMENT OF HEALTH SERVICE TRUST 

4 FUND. 

5 (a) ESTABLISHMENT.—There is hereby created on 

6 the books of the Treasury of the United States a trust 

7 fund to be known as the Health Service Trust Fund (in 

8 this title referred to as the ‘‘Trust Fund’’). The Trust 

9 Fund shall consist of such gifts and bequests as may be 

10 made to the Service and such amounts as may be depos11 ited in, or appropriated to, such fund as provided in this 

12 subtitle. 

13 (b) APPROPRIATION.—There is hereby appropriated 

14 to the Trust Fund for each fiscal year beginning in the 

15 fiscal year in which the effective date of health services 

16 (as defined in title VI) falls, and for each fiscal year there17 after, out of any moneys in the Treasury not otherwise 

18 appropriated, an amount equal to 100 percent of expected 

19 net receipts from the taxes imposed by sections 59B and 

20 3111(b) of the Internal Revenue Code of 1986 (as esti21 mated by the Secretary of the Treasury). The amount ap22 propriated by the preceding sentence shall be transferred 

23 from time to time from the general fund in the Treasury 

24 to the Trust Fund in such smaller amounts to be deter25 mined on the basis of estimates by the Secretary of the 
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1 Treasury of the receipts specified in the preceding sen2 tence; and proper adjustments shall be made in the 

3 amounts subsequently transferred to the extent prior esti4 mates were in excess of or were less than the receipts spec5 ified in such sentence. 

6 SEC. 512. TRANSFER OF FUNDS TO THE HEALTH SERVICE 

7 TRUST FUND. 

8 (a) OF MEDICARE TRUST FUNDS.—On the effective 

9 date of health services, there are transferred to the Trust 

10 Fund all of the assets and liabilities of the Federal Hos11 pital Insurance Trust Fund and the Federal Supple12 mentary Medical Insurance Trust Fund. 

13 (b) ADDITIONAL AMOUNTS.—In addition to the sums 

14 appropriated by section 511(b), there is appropriated to 

15 the Trust Fund for each fiscal year, out of any moneys 

16 in the Treasury not otherwise appropriated, a govern17 mental contribution equal to 40 percent of the sums ap18 propriated by section 511(b) for such fiscal year. There 

19 shall be deposited in the Trust Fund all recoveries of over20 payments, and all receipts under loans or other agree21 ments entered into, under this Act. 

22 SEC. 513. ADMINISTRATION OF HEALTH SERVICE TRUST 

23 FUND. 

24 (a) BOARD OF TRUSTEES.—With respect to the 

25 Trust Fund, there is hereby created a body to be known 
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1 as the Board of Trustees of the Trust Fund (in this sec2 tion referred to as the ‘‘Board of Trustees’’) composed of 

3 the Secretary of the Treasury, the Secretary of Health and 

4 Human Services, and the Chairperson of the National 

5 Health Board, all ex officio. The Secretary of the Treasury 

6 shall be the Managing Trustee of the Board of Trustees 

7 (in this section referred to as the ‘‘Managing Trustee’’). 

8 The Chairperson of the National Health Board shall serve 

9 as the Secretary of the Board of Trustees. The Board of 

10 Trustees shall meet not less frequently than once each cal11 endar year. It shall be the duty of the Board of Trustees 

12 to—

13 (1) hold the Trust Fund; 

14 (2) report to the Congress not later than the 

15 first day of April of each year on the operation and 

16 status of the Trust Fund during the preceding fiscal 

17 year and on its expected operation and status during 

18 the current fiscal year and the next 2 fiscal years; 

19 (3) report immediately to the Congress when20 ever the Board is of the opinion that the amount of 

21 the Trust Fund is unduly small; and 

22 (4) review the general policies followed in man23 aging the Trust Fund, and recommend changes in 

24 such policies, including necessary changes in the 
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1 provisions of law which govern the way in which the 

2 Trust Fund is to be managed. 

3 The report provided for in paragraph (2) shall include a 

4 statement of the assets of, and the disbursements made 

5 from, the Trust Fund during the preceding fiscal year, 

6 an estimate of the expected income to, and disbursements 

7 to be made from, the Trust Fund during the current fiscal 

8 year and each of the next 2 fiscal years, and a statement 

9 of the actuarial status of the Trust Fund. Such report 

10 shall be printed as a House document of the session of 

11 the Congress to which the report is made. 

12 (b) INVESTMENT.—It shall be the duty of the Man13 aging Trustee to invest such portion of the Trust Fund 

14 as is not, in his judgment, required to meet current with15 drawals. Such investments may be made only in interest 

16 bearing obligations of the United States or in obligations 

17 guaranteed as to both principal and interest by the United 

18 States. For such purpose such obligations may be acquired 

19 (1) on original issue at the issue price, or (2) by purchase 

20 of outstanding obligations at the market price. The pur21 poses for which obligations of the United States may be 

22 issued under the Second Liberty Bond Act, as amended, 

23 are hereby extended to authorize the issuance at par of 

24 public debt obligations for purchase by the Trust Fund. 
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1 (c) ISSUANCE OF OBLIGATIONS.—Any obligations ac2 quired by the Trust Fund (except public debt obligations 

3 issued exclusively to the Trust Fund) may be sold by the 

4 Managing Trustee at the market price, and such public 

5 debt obligations may be redeemed at par plus accrued in6 terest. 

7 (d) PAYMENT OF INTEREST.—The interest on, and 

8 the proceeds from the sale or redemption of, any obliga9 tions held in the Trust Fund shall be credited to and form 

10 a part of the Trust Fund. 

11 (e) PAYMENTS.—The Managing Trustee shall pay 

12 from time to time from the Trust Fund such amounts as 

13 the National Health Board certifies are necessary to carry 

14 out this Act. 

15 Subtitle C—Preparation of Plans 

16 and Budgets 

17 SEC. 521. DETERMINATION OF FUND AVAILABILITY. 

18 (a) MAXIMUM FUNDS.—

19 (1) FIXING.—The National Health Board shall, 

20 not later than January 1 of each year, initially fix 

21 the maximum amount of funds which may (except as 

22 provided in subsection (c)) be obligated during the 

23 fiscal year beginning on October 1 of such year for 

24 expenditure from the Trust Fund. 
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1 (2) LIMITATION.—Such amount shall not ex2 ceed for a fiscal year the lesser of—

3 (A) 140 percent of the expected net re4 ceipts during the fiscal year (as estimated by 

5 the Secretary of the Treasury) from the taxes 

6 imposed by sections 59 and 3111(b) of the In7 ternal Revenue Code of 1986; 

8 (B) the amount of the aggregate obliga9 tions that the National Health Board deter10 mines were (or will be) incurred by the Service 

11 from the Trust Fund during the previous fiscal 

12 year, adjusted to reflect changes in the cost of 

13 living, in the number of users, and in the capac14 ity of the Service to provide services under this 

15 Act; or 

16 (C) the amount fixed under subsection (b). 

17 (3) REFIXING.—The National Health Board 

18 may at any time refix such amount to reflect 

19 changes—

20 (A) of one percent or more in the expected 

21 net tax receipts (described in paragraph 

22 (2)(A)); or 

23 (B) of five percent or more in the cost of 

24 living, number of users, or the capacity of the 

25 Service to provide services under this Act. 
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1 The National Health Board shall promptly report to 

2 Congress any increase made in such amount and the 

3 reasons therefor. 

4 (b) LESSER AMOUNT.—The National Health Board 

5 shall fix in a fiscal year an amount, which the maximum 

6 amount described in subsection (a)(1) may not exceed in 

7 the fiscal year, which is less than the amount described 

8 in subsection (a)(2)(A) if the Board determines that—

9 (1) restriction of the amount to be made avail10 able for obligation will not materially impair the ade11 quacy or quality of health care and supplemental 

12 services provided to users, or 

13 (2) improvement in the organization, delivery, 

14 or utilization of such services has lessened their ag15 gregate cost (or increase in such cost). 

16 (c) OBLIGATION.—The National Health Board may 

17 obligate for expenditure from the Trust Fund, in addition 

18 to the maximum amount which may be obligated in a fis19 cal year under subsection (a), such funds as are necessary 

20 to provide health care and supplemental services needed 

21 because of an epidemic, disaster, or other occurrence 

22 which was not, and could not have been, reasonably 

23 planned for by the Board and for which the contingency 

24 fund provided in section 532(b)(7) is insufficient. The Na25 tional Health Board shall promptly report to Congress any 
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1 obligation made pursuant to this subsection and the rea2 sons therefor. 

3 (d) OBLIGATION OF BORROWED AMOUNTS.—In addi4 tion to the maximum amounts which may be obligated 

5 pursuant to subsection (a), the National Health Board 

6 may allocate funds borrowed in accordance with section 

7 541 for such purposes as it deems necessary and appro8 priate. 

9 SEC. 522. PREPARATION OF REGIONAL BUDGETS. 

10 (a) POPULATION NEED.—In preparing its annual 

11 budget the National Health Board, in coordination with 

12 its local and regional authorities, shall determine the pro13 jected per capita health expenditures for each region, 

14 based on the evaluation of health care needs described in 

15 this Act. 

16 (b) BUDGET BREAKDOWNS.—In preparing its annual 

17 budget the National Health Board shall specify its oper18 ating, prevention, capital, and research expenses antici19 pated for the fiscal year covered by the budget and for 

20 the 5-year period beginning with such fiscal year for each 

21 such region. 
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1 Subtitle D—Allocation and 

2 Distribution of Funds 

3 SEC. 531. NATIONAL BUDGET. 

4 (a) PREPARATION.—The National Health Board 

5 shall prepare, taking into consideration the budgets pre6 pared under section 522, as soon after April 1 of each 

7 year as is practicable, a national health budget for the fis8 cal year beginning on October 1 of such year. Such budget 

9 shall divide the total funds available for obligation in such 

10 year, as determined under section 521, into funds for—

11 (1) ordinary operating expenses; 

12 (2) preventive health measures, and which 

13 measures shall include primary prevention to im14 prove the conditions under which people live that af15 fect health status; 

16 (3) capital expenses; 

17 (4) research expenses; and 

18 (5) special operating expenses, as described in 

19 section 532. 

20 (b) ORDINARY OPERATING EXPENSES.—Funds for 

21 ordinary operating expenses, for preventive health meas22 ures, and for research expenses shall be divided among 

23 regions in the proportion which the number of residents 

24 in each region bears to the total population of the Nation, 

25 adjusted for population need as defined in this Act. 
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1 (c) CAPITAL EXPENSES.—Funds for capital expenses 

2 shall be allocated, to the extent consistent with the effi3 cient and equitable use of resources, except that during 

4 the first 10 fiscal years following the effective date of 

5 health services, priority shall be given to regions lacking 

6 adequate health care facilities on such effective date. 

7 SEC. 532. SPECIAL OPERATING EXPENSE FUND. 

8 (a) IN GENERAL.—A fund for special operating ex9 penses shall be incorporated into each budget prepared by 

10 the National Health Board. For the purposes of this title, 

11 the term ‘‘special operating expenses’’ means operating ex12 penses associated with—

13 (1) the care and treatment of users 65 years of 

14 age or older; 

15 (2) the care and treatment of persons confined 

16 to full-time residential care institutions, including 

17 nursing homes and facilities for the treatment of 

18 mental illness; 

19 (3) the special health care needs of low-income 

20 users; 

21 (4) the special health care needs of communities 

22 of color that experience disparities in health status 

23 compared to white populations; 
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1 (5) the special health care needs of residents of 

2 rural or frontier areas, or noncontiguous States and 

3 territories; 

4 (6) special health care needs arising from envi5 ronmental or occupational health conditions; 

6 (7) special health care needs arising from unex7 pected occurrences, including epidemics and natural 

8 disasters; and 

9 (8) the conduct of environmental health inspec10 tion and monitoring services. 

11 (b) ALLOCATION.—The special operating expense 

12 fund shall be allocated as follows: 

13 (1) Funds for the additional operating expenses 

14 associated with the care and treatment of users 65 

15 years of age or older shall be allocated and shall con16 sist of uniform basic capitation amounts multiplied 

17 by the number of residents 65 years of age or older 

18 in the respective areas. The basic capitation 

19 amounts for areas shall be determined by the Na20 tional Health Board, based upon studies of the addi21 tional operating expenses associated with the care 

22 and treatment of such residents in such areas. 

23 (2) Funds for the additional operating expenses 

24 associated with the care and treatment of persons 

25 confined to full-time residential care institutions 
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1 shall be allocated and shall consist of a uniform 

2 basic capitation amount for each kind of institution, 

3 multiplied by the number of residents in such insti4 tutions in the respective areas. The basic capitation 

5 amounts shall be determined by the National Health 

6 Board, based upon studies of the additional oper7 ating expenses associated with the care and treat8 ment of such persons and the maintenance of such 

9 institutions. 

10 (3) Funds shall be allocated to areas for the ad11 ditional operating expenses associated with the spe12 cial health care needs of low-income persons. Such 

13 payments shall be allocated in proportion to the 

14 number of residents in these areas having incomes 

15 below the poverty level (as defined by the Secretary 

16 of Commerce). The total funds allocated for this 

17 purpose shall be no less than 2 percent of the ordi18 nary operating expense funds allocated in accord19 ance with section 531(a). 

20 (4) Funds shall be allocated for the additional 

21 operating expenses associated with the special health 

22 care needs of communities of color to the extent that 

23 they experience disparities in health status compared 

24 to white populations. The basic capitation amounts 

25 shall be determined by the National Health Board, 
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1 based upon studies of the additional operating ex2 penses associated with providing the necessary or 

3 appropriate health services for communities of color, 

4 and the additional expenses associated with elimi5 nating such disparities in health status. 

6 (5) Funds for the additional operating expenses 

7 associated with the special health care needs of resi8 dents of rural or frontier areas, or noncontiguous 

9 States and territories, shall be allocated to commu10 nities serving areas of low population density and 

11 shall consist of basic capitation amounts multiplied 

12 by the number of residents in the respective areas. 

13 The basic capitation amounts shall be determined by 

14 the National Health Board based upon studies of 

15 the additional operating expenses associated with the 

16 provision of health care in areas of low population 

17 density or extreme geographic access barriers, or 

18 both. 

19 (6) Funds for the additional operating expenses 

20 associated with special regional health care needs 

21 arising from environmental and occupational health 

22 problems shall be allocated by the National Health 

23 Board in accordance with its determination of such 

24 special needs. The total funds allocated for this purpose shall be no greater than 1 25 ⁄2 of 1 percent of the 
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1 ordinary operating expense funds allocated in ac2 cordance with section 531(a). 

3 (7) Funds for the additional operating expenses 

4 associated with special health care needs arising 

5 from unexpected occurrences shall be retained by the 

6 National Health Board in a contingency fund and 

7 shall be allocated by the National Health Board in 

8 accordance with its determination of such needs. 

9 The total funds retained for this purpose in any one 

fiscal year shall be no greater than 1 10 ⁄2 of 1 percent 

11 of the ordinary operating expense funds allocated in 

12 such year in accordance with section 531(a). 

13 (8) Funds for the additional operating expenses 

14 associated with the conduct of environmental health 

15 inspection and monitoring services shall be allocated 

16 by the National Health Board for providing such 

17 services. 

18 SEC. 533. DISTRIBUTION OF FUNDS. 

19 (a) IN GENERAL.—Funds allocated under the na20 tional health budget shall be distributed by the National 

21 Health Board from the Trust Fund. Participating pro22 viders may not request or receive funds from any other 

23 source. 

24 (b) PAYMENTS AND EXPENDITURES.—All payments 

25 shall be expended in accordance with the budget adopted 
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1 under section 531. If the budget for any fiscal year is not 

2 adopted before the beginning of the fiscal year, until such 

3 budget is adopted the National Health Service shall con4 tinue to receive ordinary operating expense funds, preven5 tion expense funds, and research expense funds at the rate 

6 at which it was receiving such funds during the preceding 

7 fiscal year, and it shall receive special operating expense 

8 funds in accordance with section 532. 

9 (c) ACCOUNTS.—The National Health Board shall 

10 maintain separate accounts for—

11 (1) funds for operating expenses, including or12 dinary operating expenses and special operating ex13 penses; 

14 (2) funds for preventive health measures; 

15 (3) funds for capital expenses; and 

16 (4) funds for research expenses. 

17 Funds in a capital expense account shall be expended only 

18 for capital expenses. Funds in a research expense account 

19 shall be expended only for operations, equipment, and fa20 cilities for health and health care delivery research con21 ducted in accordance with subtitle C of title IV. Separate 

22 accounts shall not be required for funds for ordinary oper23 ating expenses and for special operating expenses. 
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1 (d) PAYMENT FREQUENCY.—Service providers under 

2 this Act shall be paid at such time or times as the National 

3 Health Board finds appropriate. 

4 (e) ALLOCATION OF SUPPLEMENTARY PAYMENTS.—

5 Before and during any fiscal year, supplementary funds 

6 may be allocated to any Service provider if the National 

7 Health Board finds that such funds are required by events 

8 occurring or information acquired after the initial alloca9 tions were made. 

10 (f) USE OF FUNDS.—Service providers may retain 

11 funds received from the National Health Board for 2 years 

12 following the receipt of such funds. Any funds which are 

13 unexpended after such time shall be returned to the Na14 tional Health Board for deposit in the Trust Fund.

15 SEC. 534. ANNUAL STATEMENT, RECORDS, AND AUDITS. 

16 (a) ANNUAL STATEMENT.—Each Service provider 

17 shall prepare annually and transmit to the National 

18 Health Board a statement which shall accurately show its 

19 financial operations and for the year for which such state20 ment is prepared. 

21 (b) RECORDKEEPING.—Each Service provider shall 

22 keep such records as determined to be necessary for the 

23 purposes of this Act, including for the facilitation of au24 dits. 
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1 (c) AUDITS.—The National Health Board and the 

2 Comptroller General of the United States, or their duly 

3 authorized representatives, shall, for the purpose of au4 dits, have access to any books, documents, papers, and 

5 records which in their opinion are related or pertinent to 

6 the operation of the Service. 

7 Subtitle E—General Provisions 

8 SEC. 541. ISSUANCE OF OBLIGATIONS. 

9 (a) BORROWING AUTHORITY.—The National Health 

10 Board is authorized to borrow money and to issue and 

11 sell such obligations as it determines necessary to carry 

12 out the purposes of this Act, but only in such amounts 

13 as may be specified from time to time in appropriation 

14 Acts. The aggregate amount of any such obligations out15 standing at any one time shall not exceed 

16 $10,000,000,000. 

17 (b) PLEDGING OF ASSETS.—The National Health 

18 Board may pledge the assets of the Trust Fund and 

19 pledge and use its revenues and receipts for the payment 

20 of the principal of or interest on such obligations, for the 

21 purchase or redemption thereof, and for other purposes 

22 incidental thereto. The National Health Board is author23 ized to enter into binding covenants with the holders of 

24 such obligations, and with the trustee, if any, under any 

25 agreement entered into in connection with the issuance 
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1 thereof with respect to the establishment of reserve, sink2 ing, and other funds, stipulations concerning the issuance 

3 of obligations or the execution of leases or lease purchases 

4 relating to properties of the Service and such other mat5 ters as the National Health Board deems necessary or de6 sirable to enhance the marketability of such obligations. 

7 (c) FORM OF OBLIGATIONS.—Obligations issued by 

8 the Service under this section—

9 (1) shall be in such forms and denominations; 

10 (2) shall be sold at such times and in such 

11 amounts; 

12 (3) shall mature at such time or times; 

13 (4) shall be sold at such prices; 

14 (5) shall bear such rates of interest; 

15 (6) may be redeemable before maturity in such 

16 manner, at such times, and at such redemption pre17 miums; 

18 (7) may be entitled to such relative priorities of 

19 claim on the assets of the Service with respect to 

20 principal and interest payments; and 

21 (8) shall be subject to other terms and condi22 tions, as the National Health Board determines. 

23 (d) CHARACTER OF OBLIGATIONS.—Obligations 

24 issued by the Service under this section shall—
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1 (1) be negotiable or nonnegotiable and bearer 

2 or registered instruments, as specified therein and in 

3 any indenture or covenant relating thereto; 

4 (2) contain a recital that they are issued under 

5 this section, and such recital shall be conclusive evi6 dence of the regularity of the issuance and sale of 

7 such obligations and of their validity; 

8 (3) be lawful investments and may be accepted 

9 as security for all fiduciary, trust, and public funds, 

10 the investment or deposit of which shall be under 

11 the authority or control of any officer or agency of 

12 the Government of the United States, and the Sec13 retary of the Treasury or any other officer or agency 

14 having authority over or control of any such fidu15 ciary, trust, or public funds, may at any time sell 

16 any of the obligations of the Service acquired under 

17 this section; 

18 (4) be exempt both as to principal and interest 

19 from all taxation now or hereafter imposed by any 

20 State or local taxing authority except estate, inherit21 ance, and gift taxes; and 

22 (5) not be obligations of, nor shall payment of 

23 the principal thereof or interest thereon be guaran24 teed by, the Government of the United States, ex25 cept as provided in subsection (g). 
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1 (e) CONSULTATION WITH TREASURY.—At least 15 

2 days before selling any issue of obligations, the National 

3 Health Board shall advise the Secretary of the Treasury 

4 of the amount, proposed date of sale, maturities, terms 

5 and conditions, and expected maximum rates of interest 

6 of the proposed issue in appropriate detail and shall con7 sult with him or his designee thereon. The Secretary may 

8 elect to purchase such obligations under such terms, in9 cluding rates of interest, as he and the National Health 

10 Board may agree, but at a rate of yield no less than the 

11 prevailing yield on outstanding marketable Treasury secu12 rities of comparable maturity, as determined by the Sec13 retary. If the Secretary does not purchase such obliga14 tions, the National Health Board may proceed to issue 

15 and sell them to a party or parties other than the Sec16 retary upon notice to the Secretary and upon consultation 

17 as to the date of issuance, maximum rates of interest, and 

18 other terms and conditions. 

19 (f) PURCHASE OF OBLIGATIONS.—Subject to the 

20 conditions of subsection (e), the National Health Board 

21 may require the Secretary of the Treasury to purchase ob22 ligations of the Service in such amounts as will not cause 

23 the holding by the Secretary of the Treasury resulting 

24 from such required purchases to exceed $2,000,000,000 

25 at any one time. This subsection shall not be construed 
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1 as limiting the authority of the Secretary to purchase obli2 gations of the Service in excess of such amount. 

3 (g) FULL FAITH AND CREDIT.—Notwithstanding 

4 subsection (d)(5), obligations issued by the Service shall 

5 be obligations of the Government of the United States, 

6 and payment of principal and interest thereon shall be 

7 fully guaranteed by the Government of the United States, 

8 such guaranty being expressed on the face thereof, if and 

9 to the extent that—

10 (1) the National Health Board requests the 

11 Secretary of the Treasury to pledge the full faith 

12 and credit of the Government of the United States 

13 for the payment of principal and interest thereon; 

14 and 

15 (2) the Secretary, in his discretion, determines 

16 that it would be in the public interest to do so. 

17 (h) PUBLIC DEBT TRANSACTION.—For the purpose 

18 of any purchase of the obligations of the Service, the Sec19 retary of the Treasury is authorized to use as a public 

20 debt transaction the proceeds from the sale of any securi21 ties issued under the Second Liberty Bond Act, as now 

22 or hereafter in force, and the purposes for which securities 

23 may be issued under the Second Liberty Bond Act, as now 

24 or hereafter in force, are extended to include any pur25 chases of the obligations of the Service under this subtitle. 
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1 The Secretary of the Treasury may, at any time, sell any 

2 of the obligations of the Service acquired by him under 

3 this chapter. All redemptions, purchases, and sales by the 

4 Secretary of the obligations of the Service shall be treated 

5 as public debt transactions of the United States. 

6 SEC. 542. DEFINITIONS. 

7 For purposes of this title: 

8 (1) OPERATING EXPENSES.—The term ‘‘oper9 ating expenses’’ means the cost of providing, plan10 ning, operating, and maintaining services, facilities, 

11 programs, and boards (other than those associated 

12 with research) established or furnished under this 

13 Act, and of capital buildings and equipment (other 

14 than those associated with research) costing less 

15 than $100,000, except for funds associated with the 

16 conduct of preventive health measures and research. 

17 (2) CAPITAL EXPENSES.—The term ‘‘capital ex18 penses’’ means expenses which under generally ac19 cepted accounting principles are not properly charge20 able as expenses of operation and maintenance, 

21 which exceed $100,000, and which are not associ22 ated primarily with the conduct of research. 
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1 TITLE VI—MISCELLANEOUS 

2 PROVISIONS 

3 SEC. 601. EFFECTIVE DATE OF HEALTH SERVICES. 

4 The effective date of health services under this Act 

5 is January 1 of the fourth calendar year after the year 

6 in which this Act is enacted. 

7 SEC. 602. REPEAL OF PROVISIONS. 

8 (a) IN GENERAL.—Effective on the effective date of 

9 health services, the following provisions of law are re10 pealed: 

11 (1) The Public Health Service Act, except for—

12 (A) title I (relating to short title and defi13 nitions), parts F and G of title III (relating to 

14 licensing and quarantine authority), and title 

15 XIV (relating to safety of public water sys16 tems); and 

17 (B) titles VII and VIII, which shall remain 

18 effective, during the period beginning on such 

19 effective date and ending on the date occurring 

20 4 years after such effective date, with respect to 

21 the provision of assistance to educational insti22 tutions, and students thereof, in areas which 

23 have not established health team schools under 

24 subtitle A of title III of this Act. 
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1 (2) Titles V, XVIII, XIX, and XXI of the So2 cial Security Act (relating to the maternal and child 

3 health and crippled children’s services, Medicare, 

4 Medicaid, and State children’s health insurance pro5 gram); part B of title XI of such Act (relating to 

6 professional standards review); sections 226, 1121 

7 through 1124, and 1126 of such Act (relating to en8 titlement to hospital insurance benefits, uniform 

9 health reporting systems, limitation on Federal par10 ticipation for capital expenditures, program for de11 termining qualification for certain health care per12 sonnel, disclosure of ownership and related informa13 tion, and disclosure of certain convictions); and so 

14 much of title XX of such Act (relating to grants to 

15 States for services) as provides for payments to 

16 States for health care and supplemental services. 

17 (3) Chapter 89 of title 5, United States Code 

18 (relating to health insurance for Federal employees). 

19 (4) Chapters 17, 73, and 81 and section 1506 

20 of title 38, United States Code (relating to medical 

21 benefits and programs relating to veterans). 

22 (5) Sections 1079 through 1083 and section 

23 1086 of title 10, United States Code (relating to the 

24 civilian health and medical program of the uni25 formed services). 
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1 (6) The Comprehensive Alcohol Abuse and Al2 coholism Prevention, Treatment, and Rehabilitation 

3 Act of 1970; the Comprehensive Alcohol Abuse and 

4 Alcoholism Prevention, Treatment, and Rehabilita5 tion Act Amendments of 1974; and section 4 of the 

6 Comprehensive Drug Abuse Prevention and Control 

7 Act of 1970 (relating to medical treatment of nar8 cotic addiction). 

9 (7) Public Law 83–568 (42 U.S.C. 2001–

10 2004b) (relating to hospital and other health facili11 ties for Indians) and Public Law 85–151 (42 U.S.C. 

12 2005–2005f) (relating to community hospitals for 

13 Indians). 

14 (8) The District of Columbia Medical Facilities 

15 Construction Act of 1968 and the District of Colum16 bia Medical and Dental Manpower Act of 1970. 

17 (9) Sections 232 and 242 and title XI of the 

18 National Housing Act (relating to mortgage insur19 ance for nursing homes, hospitals, and group prac20 tice facilities). 

21 (10) The Mental Retardation Facilities and 

22 Community Mental Health Centers Construction Act 

23 of 1963. 

24 (11) The Family Planning Services and Popu25 lation Research Act of 1970. 
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1 (12) The National Arthritis Act of 1974 and 

2 the National Diabetes Mellitus Research and Edu3 cation Act. 

4 (13) Titles I and II and section 301 of the 

5 Lead-Based Paint Poisoning Prevention Act (42 

6 U.S.C. 4801, 4811, 4821) (relating to grant pro7 grams for lead-based paint poisoning prevention). 

8 (14) The Act of March 2, 1897 (21 U.S.C. 41–

9 50) (relating to tea importation).

10 (15) Subsection (e) of section 20 and section 22 

11 of the Occupational Safety and Health Act of 1970 

12 (relating to the National Institute for Occupational 

13 Safety and Health). 

14 (b) PREPARATION OF ADDITIONAL LIST.—

15 (1) IN GENERAL.—Not later than three years 

16 after the date of enactment of this Act, the Presi17 dent shall prepare, in consultation with the appro18 priate National Health Board, and transmit to Con19 gress legislation—

20 (A) to repeal or amend such provisions of 

21 law as are inconsistent with the purposes of this 

22 Act or the provision of health care and supple23 mental services by the Service under this Act; 

24 and 
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1 (B) to make such conforming and technical 

2 amendments in provisions of law as may be nec3 essary to properly effect the repeal of provisions 

4 described in subsection (a) and the repeal or 

5 amendment of provisions described in subpara6 graph (A) of this paragraph. 

7 (2) TRANSFER AUTHORITY.—Such legislation 

8 shall include the transfers of such authority of the 

9 Secretary of Health and Human Services under the 

10 provisions of—

11 (A) the Controlled Substances Act; 

12 (B) chapter 175 of title 28, United States 

13 Code (relating to civil commitment and rehabili14 tation of narcotics addicts); 

15 (C) chapter 314 of title 18, United States 

16 Code (relating to sentencing of narcotic addicts 

17 to commitment for treatment); 

18 (D) the Narcotic Addict Rehabilitation Act 

19 of 1966; 

20 (E) the Drug Abuse Office and Treatment 

21 Act of 1972; 

22 (F) the Occupational Safety and Health 

23 Act of 1970; 

24 (G) the Lead-Based Paint Poisoning Pre25 vention Act; 
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1 (H) the Federal Cigarette Labeling and 

2 Advertising Act; 

3 (I) the Federal Food, Drug, and Cosmetic 

4 Act; 

5 (J) the Fair Packaging and Labeling Act; 

6 (K) the Act of March 4, 1923 (21 U.S.C. 

7 61–64) (relating to filled milk); 

8 (L) the Act of February 15, 1927 (21 

9 U.S.C. 141–149) (relating to milk importation); 

10 (M) the Federal Caustic Poison Act; 

11 (N) the Federal Coal Mine Health and 

12 Safety Act of 1969 (other than title IV there13 of); and 

14 (O) the Solid Waste Disposal Act, 

15 to the Service as the President determines, after 

16 consultation with the National Health Board, to be 

17 appropriate. 

18 (c) REVIEW OF PROGRAMS.—

19 (1) IN GENERAL.—The National Health Board 

20 shall, immediately upon its initial appointment, and 

21 in consultation with the Secretary of Health and 

22 Human Services, review the programs conducted 

23 under the specified provisions of the Public Health 

24 Service Act and the other Acts described in sub-
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1 section (a) and shall determine how the Service shall 

2 carry out the purposes of such programs. 

3 (2) INITIAL REPORT.—Not later than one year 

4 after the effective date of health services, the Na5 tional Health Board shall report to the President 

6 and to the Congress on how the Service is carrying 

7 out the purposes of the programs authorized to be 

8 conducted under provisions of law which are re9 pealed by subsection (a) (other than paragraph 

10 (1)(B) thereof). 

11 (3) LATER REPORT.—Not later than 5 years 

12 after the effective date of health services, the Na13 tional Health Board shall report to the President 

14 and to the Congress on how the Service is carrying 

15 out the purposes of programs described in subsection 

16 (a)(1)(B). 

17 (d) CODIFICATION PROPOSAL.—Not later than 2 

18 years after the effective date of health services, the Na19 tional Health Board shall transmit to Congress a proposed 

20 codification of all the provisions of law which contain func21 tions that are transferred or relate to the Service. 

22 SEC. 603. TRANSITION PROVISIONS. 

23 (a) TRANSFER OF APPROPRIATIONS.—Amounts ap24 propriated to carry out the purposes of any provisions of 

25 law repealed by this Act and available on the effective date 
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1 of such repeal shall be transferred on such date to the 

2 Health Service Trust Fund (established under section 511 

3 of this Act). 

4 (b) TRANSFER OF PERSONNEL, ASSETS, ETC.—The 

5 President is authorized to transfer so much of the posi6 tions, personnel, assets, liabilities, contracts, property, and 

7 records employed, held, used, arising from, available to or 

8 made available in connection with the functions or pro9 grams repealed by this Act to the Service as may be 

10 agreed upon by the President and the National Health 

11 Board. 

12 (c) LAPSES OF OFFICES.—In the case where the au13 thority for the establishment of any office or agency, or 

14 all the functions of such office or agency, are repealed 

15 under section 602, such office or agency shall lapse. 

16 (d) APPLICATION OF AMENDMENTS.—The amend17 ments made by section 602—

18 (1) shall not apply with respect to any contract 

19 entered into before the effective date of such amend20 ments, and 

21 (2) shall not affect (A) any right or obligation 

22 arising out of any matter occurring before the effec23 tive date of such amendments, or (B) any adminis24 trative or judicial proceeding (whether or not initi-
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1 ated before that date) for the adjudication or en2 forcement of any such right or obligation. 

3 SEC. 604. AMENDMENT TO BUDGET AND ACCOUNTING ACT. 

4 (a) HEALTH SERVICE BUDGET.—Section 1105 of 

5 title 31, United States Code, is amended by adding at the 

6 end the following new subsection: 

7 ‘‘(h) The Budget transmitted pursuant to subsection 

8 (a) shall set forth the items enumerated in paragraphs (4) 

9 through (9) and (12) of subsection (a) with respect to ex10 penditures from and appropriations to the Health Service 

11 Trust Fund (established under section 511 of the Jose12 phine Butler United States Health Service Act) separately 

13 from such items with respect to expenditures and appro14 priations relating to other operations of the Government.’’. 

15 (b) EFFECTIVE DATE.—The amendment made by 

16 subsection (a) shall apply with respect to fiscal years be17 ginning more than 1 year after the date of enactment of 

18 this Act. 

19 SEC. 605. SEPARABILITY. 

20 If any provision of this Act, or the application of such 

21 provision to any person or circumstance, shall be held in22 valid, the remainder of this Act, or the application of such 

23 provision to persons or circumstances other than those as 

24 to which it is held invalid, shall not be affected thereby.

Æ