I 

111TH CONGRESS 

1ST SESSION H. R. 676 

To provide for comprehensive health insurance coverage for all United States 

residents, improved health care delivery, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 26, 2009 

Mr. CONYERS (for himself, Mr. KUCINICH, Ms. WATSON, Mr. ELLISON, Mr. 

HINCHEY, Mr. DAVIS of Illinois, Ms. BALDWIN, Ms. LEE of California, 

Mr. MASSA, Mr. NADLER of New York, Mr. MCDERMOTT, Mr. DOYLE, 

Mr. GUTIERREZ, Mr. OLVER, Ms. KAPTUR, Ms. JACKSON-LEE of Texas, 

Mr. ENGEL, Mr. MEEKS of New York, Ms. CLARKE, Mr. FARR, Mrs. 

NAPOLITANO, Ms. PINGREE of Maine, Mr. TONKO, Ms. EDWARDS of 

Maryland, Mr. GRIJALVA, Mr. BERMAN, Mr. DELAHUNT, Mr. CLAY, Ms. 

KILPATRICK of Michigan, Ms. WOOLSEY, and Mr. COHEN) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means and Natural Resources, 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 provide for comprehensive health insurance coverage for 

all United States residents, improved health care delivery, and for other purposes. 

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


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘United States National Health Care Act or the Ex4 panded and Improved Medicare for All Act’’. 

5 (b) TABLE OF CONTENTS.—The table of contents of 

6 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions and terms. 

TITLE I—ELIGIBILITY AND BENEFITS 

Sec. 101. Eligibility and registration. 

Sec. 102. Benefits and portability. 

Sec. 103. Qualification of participating providers. 

Sec. 104. Prohibition against duplicating coverage. 

TITLE II—FINANCES 

Subtitle A—Budgeting and Payments 

Sec. 201. Budgeting process. 

Sec. 202. Payment of providers and health care clinicians. 

Sec. 203. Payment for long-term care. 

Sec. 204. Mental health services. 

Sec. 205. Payment for prescription medications, medical supplies, and medically 

necessary assistive equipment. 

Sec. 206. Consultation in establishing reimbursement levels. 

Subtitle B—Funding 

Sec. 211. Overview: funding the USNHC Program. 

Sec. 212. Appropriations for existing programs. 

TITLE III—ADMINISTRATION 

Sec. 301. Public administration; appointment of Director. 

Sec. 302. Office of Quality Control. 

Sec. 303. Regional and State administration; employment of displaced clerical 

workers. 

Sec. 304. Confidential Electronic Patient Record System. 

Sec. 305. National Board of Universal Quality and Access. 

TITLE IV—ADDITIONAL PROVISIONS 

Sec. 401. Treatment of VA and IHS health programs. 

Sec. 402. Public health and prevention. 

Sec. 403. Reduction in health disparities. 

TITLE V—EFFECTIVE DATE 

Sec. 501. Effective date. 


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1 SEC. 2. DEFINITIONS AND TERMS. 

2 In this Act: 

3 (1) USNHC PROGRAM; PROGRAM.—The terms 

4 ‘‘USNHC Program’’ and ‘‘Program’’ mean the pro5 gram of benefits provided under this Act and, unless 

6 the context otherwise requires, the Secretary with 

7 respect to functions relating to carrying out such 

8 program. 

9 (2) NATIONAL BOARD OF UNIVERSAL QUALITY

10 AND ACCESS.—The term ‘‘National Board of Uni11 versal Quality and Access’’ means such Board estab12 lished under section 305. 

13 (3) REGIONAL OFFICE.—The term ‘‘regional of14 fice’’ means a regional office established under sec15 tion 303. 

16 (4) SECRETARY.—The term ‘‘Secretary’’ means 

17 the Secretary of Health and Human Services. 

18 (5) DIRECTOR.—The term ‘‘Director’’ means, 

19 in relation to the Program, the Director appointed 

20 under section 301. 

21 TITLE I—ELIGIBILITY AND 

22 BENEFITS 

23 SEC. 101. ELIGIBILITY AND REGISTRATION. 

24 (a) IN GENERAL.—All individuals residing in the 

25 United States (including any territory of the United 

26 States) are covered under the USNHC Program entitling 


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1 them to a universal, best quality standard of care. Each 

2 such individual shall receive a card with a unique number 

3 in the mail. An individual’s social security number shall 

4 not be used for purposes of registration under this section. 

5 (b) REGISTRATION.—Individuals and families shall 

6 receive a United States National Health Insurance Card 

7 in the mail, after filling out a United States National 

8 Health Insurance application form at a health care pro9 vider. Such application form shall be no more than 2 pages 

10 long. 

11 (c) PRESUMPTION.—Individuals who present them12 selves for covered services from a participating provider 

13 shall be presumed to be eligible for benefits under this Act, 

14 but shall complete an application for benefits in order to 

15 receive a United States National Health Insurance Card 

16 and have payment made for such benefits. 

17 (d) RESIDENCY CRITERIA.—The Secretary shall pro18 mulgate a rule that provides criteria for determining resi19 dency for eligibility purposes under the USNHC Program. 

20 (e) COVERAGE FOR VISITORS.—The Secretary shall 

21 promulgate a rule regarding visitors from other countries 

22 who seek premeditated non-emergency surgical proce23 dures. Such a rule should facilitate the establishment of 

24 country-to-country reimbursement arrangements or self 


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1 pay arrangements between the visitor and the provider of 

2 care. 

3 SEC. 102. BENEFITS AND PORTABILITY. 

4 (a) IN GENERAL.—The health care benefits under 

5 this Act cover all medically necessary services, including 

6 at least the following: 

7 (1) Primary care and prevention. 

8 (2) Inpatient care. 

9 (3) Outpatient care. 

10 (4) Emergency care. 

11 (5) Prescription drugs. 

12 (6) Durable medical equipment. 

13 (7) Long-term care. 

14 (8) Palliative care. 

15 (9) Mental health services. 

16 (10) The full scope of dental services (other 

17 than cosmetic dentistry). 

18 (11) Substance abuse treatment services. 

19 (12) Chiropractic services. 

20 (13) Basic vision care and vision correction 

21 (other than laser vision correction for cosmetic pur22 poses). 

23 (14) Hearing services, including coverage of 

24 hearing aids. 

25 (15) Podiatric care. 


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1 (b) PORTABILITY.—Such benefits are available 

2 through any licensed health care clinician anywhere in the 

3 United States that is legally qualified to provide the bene4 fits. 

5 (c) NO COST-SHARING.—No deductibles, copay6 ments, coinsurance, or other cost-sharing shall be imposed 

7 with respect to covered benefits. 

8 SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS. 

9 (a) REQUIREMENT TO BE PUBLIC OR NON-PROF10 IT.— 

11 (1) IN GENERAL.—No institution may be a par12 ticipating provider unless it is a public or not-for13 profit institution. Private physicians, private clinics, 

14 and private health care providers shall continue to 

15 operate as private entities, but are prohibited from 

16 being investor owned. 

17 (2) CONVERSION OF INVESTOR-OWNED PRO18 VIDERS.—For-profit providers of care opting to par19 ticipate shall be required to convert to not-for-profit 

20 status. 

21 (3) PRIVATE DELIVERY OF CARE REQUIRE22 MENT.—For-profit providers of care that convert to 

23 non-profit status shall remain privately owned and 

24 operated entities. 


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1 (4) COMPENSATION FOR CONVERSION.—The 

2 owners of such for-profit providers shall be com3 pensated for reasonable financial losses incurred as 

4 a result of the conversion from for-profit to non5 profit status. 

6 (5) FUNDING.—There are authorized to be ap7 propriated from the Treasury such sums as are nec8 essary to compensate investor-owned providers as 

9 provided for under paragraph (3). 

10 (6) REQUIREMENTS.—The payments to owners 

11 of converting for-profit providers shall occur during 

12 a 15-year period, through the sale of U.S. Treasury 

13 Bonds. Payment for conversions under paragraph 

14 (3) shall not be made for loss of business profits. 

15 (7) MECHANISM FOR CONVERSION PROCESS.— 

16 The Secretary shall promulgate a rule to provide a 

17 mechanism to further the timely, efficient, and fea18 sible conversion of for-profit providers of care. 

19 (b) QUALITY STANDARDS.— 

20 (1) IN GENERAL.—Health care delivery facili21 ties must meet State quality and licensing guidelines 

22 as a condition of participation under such program, 

23 including guidelines regarding safe staffing and 

24 quality of care. 


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1 (2) LICENSURE REQUIREMENTS.—Participating 

2 clinicians must be licensed in their State of practice 

3 and meet the quality standards for their area of 

4 care. No clinician whose license is under suspension 

5 or who is under disciplinary action in any State may 

6 be a participating provider. 

7 (c) PARTICIPATION OF HEALTH MAINTENANCE OR8 GANIZATIONS.— 

9 (1) IN GENERAL.—Non-profit health mainte10 nance organizations that deliver care in their own 

11 facilities and employ clinicians on a salaried basis 

12 may participate in the program and receive global 

13 budgets or capitation payments as specified in sec14 tion 202. 

15 (2) EXCLUSION OF CERTAIN HEALTH MAINTE16 NANCE ORGANIZATIONS.—Other health maintenance 

17 organizations, including those which principally con18 tract to pay for services delivered by non-employees, 

19 shall be classified as insurance plans. Such organiza20 tions shall not be participating providers, and are 

21 subject to the regulations promulgated by reason of 

22 section 104(a) (relating to prohibition against dupli23 cating coverage). 


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1 (d) FREEDOM OF CHOICE.—Patients shall have free 

2 choice of participating physicians and other clinicians, 

3 hospitals, and inpatient care facilities. 

4 SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE. 

5 (a) IN GENERAL.—It is unlawful for a private health 

6 insurer to sell health insurance coverage that duplicates 

7 the benefits provided under this Act. 

8 (b) CONSTRUCTION.—Nothing in this Act shall be 

9 construed as prohibiting the sale of health insurance cov10 erage for any additional benefits not covered by this Act, 

11 such as for cosmetic surgery or other services and items 

12 that are not medically necessary. 

13 TITLE II—FINANCES 

14 Subtitle A—Budgeting and 

15 Payments 

16 SEC. 201. BUDGETING PROCESS. 

17 (a) ESTABLISHMENT OF OPERATING BUDGET AND

18 CAPITAL EXPENDITURES BUDGET.— 

19 (1) IN GENERAL.—To carry out this Act there 

20 are established on an annual basis consistent with 

21 this title— 

22 (A) an operating budget, including 

23 amounts for optimal physician, nurse, and other 

24 health care professional staffing; 

25 (B) a capital expenditures budget; 


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1 (C) reimbursement levels for providers con2 sistent with subtitle B; and 

3 (D) a health professional education budget, 

4 including amounts for the continued funding of 

5 resident physician training programs. 

6 (2) REGIONAL ALLOCATION.—After Congress 

7 appropriates amounts for the annual budget for the 

8 USNHC Program, the Director shall provide the re9 gional offices with an annual funding allotment to 

10 cover the costs of each region’s expenditures. Such 

11 allotment shall cover global budgets, reimbursements 

12 to clinicians, health professional education, and cap13 ital expenditures. Regional offices may receive addi14 tional funds from the national program at the dis15 cretion of the Director. 

16 (b) OPERATING BUDGET.—The operating budget 

17 shall be used for— 

18 (1) payment for services rendered by physicians 

19 and other clinicians; 

20 (2) global budgets for institutional providers; 

21 (3) capitation payments for capitated groups; 

22 and 

23 (4) administration of the Program. 

24 (c) CAPITAL EXPENDITURES BUDGET.—The capital 

25 expenditures budget shall be used for funds needed for— 


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1 (1) the construction or renovation of health fa2 cilities; and 

3 (2) for major equipment purchases. 

4 (d) PROHIBITION AGAINST CO-MINGLING OPER5 ATIONS AND CAPITAL IMPROVEMENT FUNDS.—It is pro6 hibited to use funds under this Act that are earmarked— 

7 (1) for operations for capital expenditures; or 

8 (2) for capital expenditures for operations. 

9 SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLI10 NICIANS. 

11 (a) ESTABLISHING GLOBAL BUDGETS; MONTHLY

12 LUMP SUM.— 

13 (1) IN GENERAL.—The USNHC Program, 

14 through its regional offices, shall pay each institu15 tional provider of care, including hospitals, nursing 

16 homes, community or migrant health centers, home 

17 care agencies, or other institutional providers or pre18 paid group practices, a monthly lump sum to cover 

19 all operating expenses under a global budget. 

20 (2) ESTABLISHMENT OF GLOBAL BUDGETS.— 

21 The global budget of a provider shall be set through 

22 negotiations between providers, State directors, and 

23 regional directors, but are subject to the approval of 

24 the Director. The budget shall be negotiated annu25 ally, based on past expenditures, projected changes 


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1 in levels of services, wages and input, costs, a pro2 vider’s maximum capacity to provide care, and pro3 posed new and innovative programs. 

4 (b) THREE PAYMENT OPTIONS FOR PHYSICIANS AND

5 CERTAIN OTHER HEALTH PROFESSIONALS.— 

6 (1) IN GENERAL.—The Program shall pay phy7 sicians, dentists, doctors of osteopathy, pharmacists, 

8 psychologists, chiropractors, doctors of optometry, 

9 nurse practitioners, nurse midwives, physicians’ as10 sistants, and other advanced practice clinicians as li11 censed and regulated by the States by the following 

12 payment methods: 

13 (A) Fee for service payment under para14 graph (2). 

15 (B) Salaried positions in institutions re16 ceiving global budgets under paragraph (3). 

17 (C) Salaried positions within group prac18 tices or non-profit health maintenance organiza19 tions receiving capitation payments under para20 graph (4). 

21 (2) FEE FOR SERVICE.— 

22 (A) IN GENERAL.—The Program shall ne23 gotiate a simplified fee schedule that is fair and 

24 optimal with representatives of physicians and 

25 other clinicians, after close consultation with 


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1 the National Board of Universal Quality and 

2 Access and regional and State directors. Ini3 tially, the current prevailing fees or reimburse4 ment would be the basis for the fee negotiation 

5 for all professional services covered under this 

6 Act. 

7 (B) CONSIDERATIONS.—In establishing 

8 such schedule, the Director shall take into con9 sideration the following: 

10 (i) The need for a uniform national 

11 standard. 

12 (ii) The goal of ensuring that physi13 cians, clinicians, pharmacists, and other 

14 medical professionals be compensated at a 

15 rate which reflects their expertise and the 

16 value of their services, regardless of geo17 graphic region and past fee schedules. 

18 (C) STATE PHYSICIAN PRACTICE REVIEW

19 BOARDS.—The State director for each State, in 

20 consultation with representatives of the physi21 cian community of that State, shall establish 

22 and appoint a physician practice review board 

23 to assure quality, cost effectiveness, and fair re24 imbursements for physician delivered services. 


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1 (D) FINAL GUIDELINES.—The Director 

2 shall be responsible for promulgating final 

3 guidelines to all providers. 

4 (E) BILLING.—Under this Act physicians 

5 shall submit bills to the regional director on a 

6 simple form, or via computer. Interest shall be 

7 paid to providers who are not reimbursed within 

8 30 days of submission. 

9 (F) NO BALANCE BILLING.—Licensed 

10 health care clinicians who accept any payment 

11 from the USNHC Program may not bill any 

12 patient for any covered service. 

13 (G) UNIFORM COMPUTER ELECTRONIC

14 BILLING SYSTEM.—The Director shall create a 

15 uniform computerized electronic billing system, 

16 including those areas of the United States 

17 where electronic billing is not yet established. 

18 (3) SALARIES WITHIN INSTITUTIONS RECEIVING

19 GLOBAL BUDGETS.— 

20 (A) IN GENERAL.—In the case of an insti21 tution, such as a hospital, health center, group 

22 practice, community and migrant health center, 

23 or a home care agency that elects to be paid a 

24 monthly global budget for the delivery of health 

25 care as well as for education and prevention 


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1 programs, physicians and other clinicians em2 ployed by such institutions shall be reimbursed 

3 through a salary included as part of such a 

4 budget. 

5 (B) SALARY RANGES.—Salary ranges for 

6 health care providers shall be determined in the 

7 same way as fee schedules under paragraph (2). 

8 (4) SALARIES WITHIN CAPITATED GROUPS.— 

9 (A) IN GENERAL.—Health maintenance or10 ganizations, group practices, and other institu11 tions may elect to be paid capitation payments 

12 to cover all outpatient, physician, and medical 

13 home care provided to individuals enrolled to 

14 receive benefits through the organization or en15 tity. 

16 (B) SCOPE.—Such capitation may include 

17 the costs of services of licensed physicians and 

18 other licensed, independent practitioners pro19 vided to inpatients. Other costs of inpatient and 

20 institutional care shall be excluded from capita21 tion payments, and shall be covered under insti22 tutions’ global budgets. 

23 (C) PROHIBITION OF SELECTIVE ENROLL24 MENT.—Patients shall be permitted to enroll or 

25 disenroll from such organizations or entities 


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1 without discrimination and with appropriate no2 tice. 

3 (D) HEALTH MAINTENANCE ORGANIZA4 TIONS.—Under this Act— 

5 (i) health maintenance organizations 

6 shall be required to reimburse physicians 

7 based on a salary; and 

8 (ii) financial incentives between such 

9 organizations and physicians based on uti10 lization are prohibited. 

11 SEC. 203. PAYMENT FOR LONG-TERM CARE. 

12 (a) ALLOTMENT FOR REGIONS.—The Program shall 

13 provide for each region a single budgetary allotment to 

14 cover a full array of long-term care services under this 

15 Act. 

16 (b) REGIONAL BUDGETS.—Each region shall provide 

17 a global budget to local long-term care providers for the 

18 full range of needed services, including in-home, nursing 

19 home, and community based care. 

20 (c) BASIS FOR BUDGETS.—Budgets for long-term 

21 care services under this section shall be based on past ex22 penditures, financial and clinical performance, utilization, 

23 and projected changes in service, wages, and other related 

24 factors. 


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1 (d) FAVORING NON-INSTITUTIONAL CARE.—All ef2 forts shall be made under this Act to provide long-term 

3 care in a home- or community-based setting, as opposed 

4 to institutional care. 

5 SEC. 204. MENTAL HEALTH SERVICES. 

6 (a) IN GENERAL.—The Program shall provide cov7 erage for all medically necessary mental health care on 

8 the same basis as the coverage for other conditions. Li9 censed mental health clinicians shall be paid in the same 

10 manner as specified for other health professionals, as pro11 vided for in section 202(b). 

12 (b) FAVORING COMMUNITY-BASED CARE.—The 

13 USNHC Program shall cover supportive residences, occu14 pational therapy, and ongoing mental health and coun15 seling services outside the hospital for patients with seri16 ous mental illness. In all cases the highest quality and 

17 most effective care shall be delivered, and, for some indi18 viduals, this may mean institutional care. 

19 SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, 

20 MEDICAL SUPPLIES, AND MEDICALLY NEC21 ESSARY ASSISTIVE EQUIPMENT. 

22 (a) NEGOTIATED PRICES.—The prices to be paid 

23 each year under this Act for covered pharmaceuticals, 

24 medical supplies, and medically necessary assistive equip25 ment shall be negotiated annually by the Program. 


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1 (b) PRESCRIPTION DRUG FORMULARY.— 

2 (1) IN GENERAL.—The Program shall establish 

3 a prescription drug formulary system, which shall 

4 encourage best-practices in prescribing and discour5 age the use of ineffective, dangerous, or excessively 

6 costly medications when better alternatives are avail7 able. 

8 (2) PROMOTION OF USE OF GENERICS.—The 

9 formulary shall promote the use of generic medica10 tions but allow the use of brand-name and off-for11 mulary medications. 

12 (3) FORMULARY UPDATES AND PETITION

13 RIGHTS.—The formulary shall be updated frequently 

14 and clinicians and patients may petition their region 

15 or the Director to add new pharmaceuticals or to re16 move ineffective or dangerous medications from the 

17 formulary. 

18 SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSE19 MENT LEVELS. 

20 Reimbursement levels under this subtitle shall be set 

21 after close consultation with regional and State Directors 

22 and after the annual meeting of National Board of Uni23 versal Quality and Access. 


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1 Subtitle B—Funding 

2 SEC. 211. OVERVIEW: FUNDING THE USNHC PROGRAM. 

3 (a) IN GENERAL.—The USNHC Program is to be 

4 funded as provided in subsection (c)(1). 

5 (b) USNHC TRUST FUND.—There shall be estab6 lished a USNHC Trust Fund in which funds provided 

7 under this section are deposited and from which expendi8 tures under this Act are made. 

9 (c) FUNDING.— 

10 (1) IN GENERAL.—There are appropriated to 

11 the USNHC Trust Fund amounts sufficient to carry 

12 out this Act from the following sources: 

13 (A) Existing sources of Federal Govern14 ment revenues for health care. 

15 (B) Increasing personal income taxes on 

16 the top 5 percent income earners. 

17 (C) Instituting a modest and progressive 

18 excise tax on payroll and self-employment in19 come. 

20 (D) Instituting a small tax on stock and 

21 bond transactions. 

22 (2) SYSTEM SAVINGS AS A SOURCE OF FINANC23 ING.—Funding otherwise required for the Program 

24 is reduced as a result of— 

25 (A) vastly reducing paperwork; 


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1 (B) requiring a rational bulk procurement 

2 of medications under section 205(a); and 

3 (C) improved access to preventive health 

4 care. 

5 (3) ADDITIONAL ANNUAL APPROPRIATIONS TO

6 USNHC PROGRAM.—Additional sums are authorized 

7 to be appropriated annually as needed to maintain 

8 maximum quality, efficiency, and access under the 

9 Program. 

10 SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS. 

11 Notwithstanding any other provision of law, there are 

12 hereby transferred and appropriated to carry out this Act, 

13 amounts from the Treasury equivalent to the amounts the 

14 Secretary estimates would have been appropriated and ex15 pended for Federal public health care programs, including 

16 funds that would have been appropriated under the Medi17 care program under title XVIII of the Social Security Act, 

18 under the Medicaid program under title XIX of such Act, 

19 and under the Children’s Health Insurance Program 

20 under title XXI of such Act. 


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1 TITLE III—ADMINISTRATION 

2 SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DI3 RECTOR. 

4 (a) IN GENERAL.—Except as otherwise specifically 

5 provided, this Act shall be administered by the Secretary 

6 through a Director appointed by the Secretary. 

7 (b) LONG-TERM CARE.—The Director shall appoint 

8 a director for long-term care who shall be responsible for 

9 administration of this Act and ensuring the availability 

10 and accessibility of high quality long-term care services. 

11 (c) MENTAL HEALTH.—The Director shall appoint a 

12 director for mental health who shall be responsible for ad13 ministration of this Act and ensuring the availability and 

14 accessibility of high quality mental health services. 

15 SEC. 302. OFFICE OF QUALITY CONTROL. 

16 The Director shall appoint a director for an Office 

17 of Quality Control. Such director shall, after consultation 

18 with state and regional directors, provide annual rec19 ommendations to Congress, the President, the Secretary, 

20 and other Program officials on how to ensure the highest 

21 quality health care service delivery. The director of the Of22 fice of Quality Control shall conduct an annual review on 

23 the adequacy of medically necessary services, and shall 

24 make recommendations of any proposed changes to the 


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1 Congress, the President, the Secretary, and other USNHC 

2 Program officials. 

3 SEC. 303. REGIONAL AND STATE ADMINISTRATION; EM4 PLOYMENT OF DISPLACED CLERICAL WORK5 ERS. 

6 (a) ESTABLISHMENT OF USNHC PROGRAM RE7 GIONAL OFFICES.—The Secretary shall establish and 

8 maintain USNHC regional offices for the purpose of dis9 tributing funds to providers of care. Whenever possible, 

10 the Secretary should incorporate pre-existing Medicare in11 frastructure for this purpose. 

12 (b) APPOINTMENT OF REGIONAL AND STATE DIREC13 TORS.—In each such regional office there shall be— 

14 (1) one regional director appointed by the Di15 rector; and 

16 (2) for each State in the region, a deputy direc17 tor (in this Act referred to as a ‘‘State Director’’) 

18 appointed by the governor of that State. 

19 (c) REGIONAL OFFICE DUTIES.—Regional offices of 

20 the Program shall be responsible for— 

21 (1) coordinating funding to health care pro22 viders and physicians; and 

23 (2) coordinating billing and reimbursements 

24 with physicians and health care providers through a 

25 State-based reimbursement system. 


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1 (d) STATE DIRECTOR’S DUTIES.—Each State Direc2 tor shall be responsible for the following duties: 

3 (1) Providing an annual state health care needs 

4 assessment report to the National Board of Uni5 versal Quality and Access, and the regional board, 

6 after a thorough examination of health needs, in 

7 consultation with public health officials, clinicians, 

8 patients, and patient advocates. 

9 (2) Health planning, including oversight of the 

10 placement of new hospitals, clinics, and other health 

11 care delivery facilities. 

12 (3) Health planning, including oversight of the 

13 purchase and placement of new health equipment to 

14 ensure timely access to care and to avoid duplica15 tion. 

16 (4) Submitting global budgets to the regional 

17 director. 

18 (5) Recommending changes in provider reim19 bursement or payment for delivery of health services 

20 in the State. 

21 (6) Establishing a quality assurance mechanism 

22 in the State in order to minimize both under utiliza23 tion and over utilization and to assure that all pro24 viders meet high quality standards. 


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1 (7) Reviewing program disbursements on a 

2 quarterly basis and recommending needed adjust3 ments in fee schedules needed to achieve budgetary 

4 targets and assure adequate access to needed care. 

5 (e) FIRST PRIORITY IN RETRAINING AND JOB

6 PLACEMENT; 2 YEARS OF SALARY PARITY BENEFITS.— 

7 The Program shall provide that clerical, administrative, 

8 and billing personnel in insurance companies, doctors of9 fices, hospitals, nursing facilities, and other facilities 

10 whose jobs are eliminated due to reduced administration— 

11 (1) should have first priority in retraining and 

12 job placement in the new system; and 

13 (2) shall be eligible to receive two years of 

14 USNHC employment transition benefits with each 

15 year’s benefit equal to salary earned during the last 

16 12 months of employment, but shall not exceed 

17 $100,000 per year. 

18 (f) ESTABLISHMENT OF USNHC EMPLOYMENT

19 TRANSITION FUND.—The Secretary shall establish a trust 

20 fund from which expenditures shall be made to recipients 

21 of the benefits allocated in subsection (e). 

22 (g) ANNUAL APPROPRIATIONS TO USNHC EMPLOY23 MENT TRANSITION FUND.—Sums are authorized to be ap24 propriated annually as needed to fund the USNHC Em25 ployment Transition Benefits. 


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1 (h) RETENTION OF RIGHT TO UNEMPLOYMENT BEN2 EFITS.—Nothing in this section shall be interpreted as a 

3 waiver of USNHC Employment Transition benefit recipi4 ents’ right to receive Federal and State unemployment 

5 benefits. 

6 SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD 

7 SYSTEM. 

8 (a) IN GENERAL.—The Secretary shall create a 

9 standardized, confidential electronic patient record system 

10 in accordance with laws and regulations to maintain accu11 rate patient records and to simplify the billing process, 

12 thereby reducing medical errors and bureaucracy. 

13 (b) PATIENT OPTION.—Notwithstanding that all bill14 ing shall be preformed electronically, patients shall have 

15 the option of keeping any portion of their medical records 

16 separate from their electronic medical record. 

17 SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND 

18 ACCESS. 

19 (a) ESTABLISHMENT.— 

20 (1) IN GENERAL.—There is established a Na21 tional Board of Universal Quality and Access (in 

22 this section referred to as the ‘‘Board’’) consisting 

23 of 15 members appointed by the President, by and 

24 with the advice and consent of the Senate. 


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1 (2) QUALIFICATIONS.—The appointed members 

2 of the Board shall include at least one of each of the 

3 following: 

4 (A) Health care professionals. 

5 (B) Representatives of institutional pro6 viders of health care. 

7 (C) Representatives of health care advo8 cacy groups. 

9 (D) Representatives of labor unions. 

10 (E) Citizen patient advocates. 

11 (3) TERMS.—Each member shall be appointed 

12 for a term of 6 years, except that the President shall 

13 stagger the terms of members initially appointed so 

14 that the term of no more than 3 members expires 

15 in any year. 

16 (4) PROHIBITION ON CONFLICTS OF INTER17 EST.—No member of the Board shall have a finan18 cial conflict of interest with the duties before the 

19 Board. 

20 (b) DUTIES.— 

21 (1) IN GENERAL.—The Board shall meet at 

22 least twice per year and shall advise the Secretary 

23 and the Director on a regular basis to ensure qual24 ity, access, and affordability. 


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1 (2) SPECIFIC ISSUES.—The Board shall specifi2 cally address the following issues: 

3 (A) Access to care. 

4 (B) Quality improvement. 

5 (C) Efficiency of administration. 

6 (D) Adequacy of budget and funding. 

7 (E) Appropriateness of reimbursement lev8 els of physicians and other providers. 

9 (F) Capital expenditure needs. 

10 (G) Long-term care. 

11 (H) Mental health and substance abuse 

12 services. 

13 (I) Staffing levels and working conditions 

14 in health care delivery facilities. 

15 (3) ESTABLISHMENT OF UNIVERSAL, BEST

16 QUALITY STANDARD OF CARE.—The Board shall 

17 specifically establish a universal, best quality of 

18 standard of care with respect to— 

19 (A) appropriate staffing levels; 

20 (B) appropriate medical technology; 

21 (C) design and scope of work in the health 

22 workplace; 

23 (D) best practices; and 


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1 (E) salary level and working conditions of 

2 physicians, clinicians, nurses, other medical pro3 fessionals, and appropriate support staff. 

4 (4) TWICE-A-YEAR REPORT.—The Board shall 

5 report its recommendations twice each year to the 

6 Secretary, the Director, Congress, and the Presi7 dent. 

8 (c) COMPENSATION, ETC.—The following provisions 

9 of section 1805 of the Social Security Act shall apply to 

10 the Board in the same manner as they apply to the Medi11 care Payment Assessment Commission (except that any 

12 reference to the Commission or the Comptroller General 

13 shall be treated as references to the Board and the Sec14 retary, respectively): 

15 (1) Subsection (c)(4) (relating to compensation 

16 of Board members). 

17 (2) Subsection (c)(5) (relating to chairman and 

18 vice chairman). 

19 (3) Subsection (c)(6) (relating to meetings). 

20 (4) Subsection (d) (relating to director and 

21 staff; experts and consultants). 

22 (5) Subsection (e) (relating to powers). 


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1 TITLE IV—ADDITIONAL 

2 PROVISIONS 

3 SEC. 401. TREATMENT OF VA AND IHS HEALTH PROGRAMS. 

4 (a) VA HEALTH PROGRAMS.—This Act provides for 

5 health programs of the Department of Veterans’ Affairs 

6 to initially remain independent for the 10-year period that 

7 begins on the date of the establishment of the USNHC 

8 Program. After such 10-year period, the Congress shall 

9 reevaluate whether such programs shall remain inde10 pendent or be integrated into the USNHC Program. 

11 (b) INDIAN HEALTH SERVICE PROGRAMS.—This Act 

12 provides for health programs of the Indian Health Service 

13 to initially remain independent for the 5-year period that 

14 begins on the date of the establishment of the USNHC 

15 Program, after which such programs shall be integrated 

16 into the USNHC Program. 

17 SEC. 402. PUBLIC HEALTH AND PREVENTION. 

18 It is the intent of this Act that the Program at all 

19 times stress the importance of good public health through 

20 the prevention of diseases. 

21 SEC. 403. REDUCTION IN HEALTH DISPARITIES. 

22 It is the intent of this Act to reduce health disparities 

23 by race, ethnicity, income and geographic region, and to 

24 provide high quality, cost-effective, culturally appropriate 


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1 care to all individuals regardless of race, ethnicity, sexual 

2 orientation, or language. 

3 TITLE V—EFFECTIVE DATE 

4 SEC. 501. EFFECTIVE DATE. 

5 Except as otherwise specifically provided, this Act 

6 shall take effect on the first day of the first year that be7 gins more than 1 year after the date of the enactment 

8 of this Act, and shall apply to items and services furnished 

9 on or after such date. 

Æ 


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