I

103D CONGRESS

1ST SESSION H. R. 257

To establish a Health Care Crisis Policy Commission.

IN THE HOUSE OF REPRESENTATIVES

JANUARY 5, 1993

Mr. NEAL of North Carolina introduced the following bill; which was referred

jointly to the Committees on Energy and Commerce and Ways and Means

A BILL

To establish a Health Care Crisis Policy Commission.

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.

4 This Act may be cited as the ‘‘Health Care Crisis

5 Policy Commission Act’’.

6 SEC. 2. CONGRESSIONAL FINDINGS.

7 The Congress finds that—

8 (1) the people of the United States will find it

9 increasingly difficult to pay for their medical care if

10 the cost of such care continues to increase;

11 (2) in 1988, an estimated 37,000,000 individ12 uals in the United States lacked health insurance
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1 and another 50,000,000 were underinsured, leading

2 to high levels of uncompensated medical care;

3 (3) there exists a tremendous need in the Unit4 ed States for access to basic medical care services;

5 (4) as the average age of individuals in the

6 United States increases, there will be a growing de7 mand for health care;

8 (5) in 1988, the average cost of a stay of 1 year

9 in a long-term health care facility was $25,000;

10 (6) adequate long-term health care insurance is

11 unavailable;

12 (7) the medical care system of the Department

13 of Veterans Affairs is not adequate to deal with the

14 health care needs of American veterans;

15 (8) 11 percent of the gross national product of

16 the United States is made up of spending for medi17 cal care;

18 (9) medical malpractice tort reform is necessary

19 because the high cost of malpractice insurance in20 flates medical costs;

21 (10) there is a shortage of prenatal, infant de22 livery, and well-baby care services in the United

23 States even though it has been proven that such

24 services reduce medical costs over the long term;
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1 (11) a large percentage of health care expendi2 tures are made for extraordinary medical procedures

3 performed near the end of individuals’ lives rather

4 than for preventative measures early in their lives;

5 (12) Federal income tax incentives for em6 ployer-paid group health insurance need to be im7 proved;

8 (13) businesses that offer only self-insured

9 health care coverage for their employees need to

10 have such coverage regulated to guarantee adequate

11 coverage, as such coverage is the fastest growing

12 segment of health care insurance;

13 (14) concern exists regarding the continued sol14 vency of the medicare system with physicians becom15 ing reluctant to participate because Federal payment

16 rates are too low; and

17 (15) health care in many rural areas is inad18 equate and some rural hospitals are closing.

19 SEC. 3. ESTABLISHMENT.

20 There is established a commission to be known as the

21 ‘‘Health Care Crisis Policy Commission’’ (in this Act re22 ferred to as the ‘‘Commission’’).
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1 SEC. 4. DUTIES.

2 The Commission shall conduct a study of the prob3 lems of the cost and delivery of medical care in the United

4 States. In conducting the study, the Commission shall—

5 (1) examine the escalating costs of medical care

6 and health care insurance and its effect on the avail7 ability of medical care to individuals in the United

8 States;

9 (2) investigate alternatives for providing medi10 cal care to individuals who do not have health care

11 insurance or who do not have adequate health care

12 insurance;

13 (3) evaluate how the private sector could most

14 effectively offer adequate health care insurance to all

15 employed individuals in the United States;

16 (4) review the demands that will be placed on

17 the Nation’s health care system in the future as the

18 population of the United States ages;

19 (5) examine the costs of long-term institutional

20 and home health care and the affordability and

21 availability of insurance for such care;

22 (6) evaluate the health care delivery system of

23 the Department of Veterans Affairs;

24 (7) investigate reforms that could be made to

25 the medical malpractice liability system and the ef-
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1 fect such system has on medical malpractice insur2 ance and on the cost of health care;

3 (8) examine the need for prenatal, delivery, and

4 well-baby health care and how such care impacts on

5 the cost of health care in the long term;

6 (9) review the Federal income tax incentives

7 used by businesses for employer-sponsored group

8 health insurance;

9 (10) research the trend of businesses to be self10 insured in their health insurance coverage and how

11 such coverage is regulated;

12 (11) examine the delivery of health care in the

13 rural areas of the United States and the reasons for

14 the closing of many of the hospitals in those areas;

15 (12) evaluate the financial stability and effec16 tiveness of, and physician reimbursements from, title

17 XVIII of the Social Security Act (42 U.S.C. 1395–

18 1395ccc; commonly known as medicare);

19 (13) investigate financing options and costs for

20 each health care delivery system recommended by

21 the Commission as an alternative to the systems

22 used in the United States as of the date of the en23 actment of this Act;

24 (14) investigate systems of organizing and de25 livering health care and types of incentives that
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1 could be used to improve the efficiency of the provi2 sion of health care while improving the quality of

3 care; and

4 (15) investigate other areas relating to the effi5 cient and cost-effective delivery of health care that

6 the Commission believes it is necessary to inves7 tigate.

8 SEC. 5. MEMBERSHIP.

9 (a) NUMBER AND APPOINTMENT.—The Commission

10 shall be composed of 15 members appointed as follows:

11 (1) 5 members appointed by the President.

12 (2) 5 members appointed by the Speaker of the

13 House of Representatives.

14 (3) 5 members appointed by the majority leader

15 of the Senate.

16 (b) QUALIFICATIONS FOR AND LIMITATIONS ON AP17 POINTMENT.—Each member shall be knowledgeable about

18 the delivery or the financing of health care, or both, or

19 in the economics, administration, or legal aspects of health

20 care. Each member shall be selected from among consum21 ers of health care, health care providers, employers, health

22 care financial institutions, or organizations that represent

23 such persons. Not more than 1 member appointed under

24 each paragraph of subsection (a) may be—
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1 (1) an officer or employee of the Federal Gov2 ernment;

3 (2) an officer or employee of a State or local

4 government; or

5 (3) a Member of the Congress.

6 (c) VACANCIES.—A vacancy in the Commission shall

7 be filled in the manner in which the original appointment

8 was made.

9 (d) POLITICAL AFFILIATION.—Not more than 3

10 members of the Commission appointed under each para11 graph of subsection (a) may be of the same political party.

12 (e) TERMS.—Each member shall be appointed for the

13 life of the Commission.

14 (f) BASIC PAY.—

15 (1) RATES OF PAY.—Except as provided in

16 paragraph (2), members of the Commission shall

17 each be paid at a rate equal to the rate of basic pay

18 payable for level IV of the Executive Schedule for

19 each day (including travel time) during which they

20 are engaged in the actual performance of duties

21 vested in the Commission.

22 (2) PAY OF FEDERAL EMPLOYEES AND MEM23 BERS OF CONGRESS.—Members of the Commission

24 who are full-time officers or employees of the Fed25 eral Government or Members of the Congress shall
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1 receive no additional pay, allowances, or benefits, ex2 cept those provided in paragraph (3), by reason of

3 their service on the Commission.

4 (3) TRAVEL EXPENSES.—Each member of the

5 Commission shall receive travel expenses, including

6 per diem in lieu of subsistence, in the same manner

7 as is permitted under sections 5702 and 5703 of

8 title 5, United States Code.

9 (g) QUORUM.—8 members of the Commission shall

10 constitute a quorum, but a lesser number may hold hear11 ings.

12 (h) CHAIRMAN AND VICE CHAIRMAN.—The chairman

13 and vice chairman of the Commission shall be elected by

14 the members of the Commission.

15 (i) MEETINGS.—The Commission shall meet at the

16 call of the chairman of the Commission or a majority of

17 its members.

18 SEC. 6. STAFF; EXPERTS AND CONSULTANTS.

19 (a) IN GENERAL.—The chairman of the Commission

20 shall, in accordance with the provisions of title 5, United

21 States Code, governing appointments in the competitive

22 service, and other applicable laws and regulations, hire

23 such staff as is necessary to carry out the duties of the

24 Commission.
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1 (b) PAY.—The staff of the Commission shall be paid

2 in accordance with the provisions of chapter 51 and sub3 chapter III of chapter 53 of title 5, United States Code,

4 relating to classification and General Schedule pay rates.

5 (c) EXPERTS AND CONSULTANTS.—The chairman

6 may procure temporary and intermittent services of ex7 perts and consultants under section 3109(b) of title 5,

8 United States Code.

9 (d) STAFF OF FEDERAL AGENCIES.—Upon request

10 of the Commission, the head of any Federal agency is au11 thorized to detail, on a reimbursable basis, any of the per12 sonnel of such agency to the Commission to assist the

13 Commission in carrying out its duties under this Act.

14 SEC. 7. POWERS.

15 (a) HEARINGS AND SESSIONS.—

16 (1) IN GENERAL.—The Commission may, for

17 the purpose of carrying out this Act, hold hearings,

18 sit and act at times and places, take testimony, and

19 receive evidence, as the Commission considers appro20 priate.

21 (2) OPEN MEETINGS.—The Commission shall

22 be considered an agency for the purposes of section

23 552b of title 5, United States Code (relating to the

24 requirement that meetings of Federal agencies be

25 open to the public).
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1 (b) POWERS OF MEMBERS AND AGENTS.—Any mem2 ber or agent of the Commission may, if so authorized by

3 the Commission, take any action which the Commission

4 is authorized to take by this section.

5 (c) OBTAINING OFFICIAL DATA.—All officers and

6 employees of Federal agencies shall cooperate with the

7 Commission in the performance of the duties of the Com8 mission. Subject to sections 552 and 552a of title 5, Unit9 ed States Code (relating to the availability of information

10 of Federal agencies to the public), the Commission may

11 secure directly from any Federal agency information nec12 essary to enable it to carry out this Act. Upon request

13 of the Chairman of the Commission, the head of the Fed14 eral agency shall furnish the information to the Commis15 sion.

16 (d) GIFTS.—The Commission may accept, use, and

17 dispose of gifts or donations of services or property.

18 (e) MAILS.—The Commission may use the United

19 States mails in the same manner and under the same con20 ditions as other Federal agencies.

21 (f) ADMINISTRATIVE SUPPORT SERVICES.—The Ad22 ministrator of General Services shall provide to the Com23 mission on a reimbursable basis such administrative sup24 port services as the Commission may request.
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1 SEC. 8. REPORT.

2 The Commission shall transmit to the President and

3 to the Congress a report not later than 2 years after the

4 date of enactment of this Act. The report shall contain

5 a detailed statement of the findings and conclusions of the

6 study conducted pursuant to section 4, together with the

7 recommendations of the Commission for such legislation

8 and administrative actions, at the Federal, State, and

9 local level, and for actions that should be undertaken by

10 the private sector, as the Commission considers appro11 priate.

12 SEC. 9. TERMINATION.

13 The Commission shall cease to exist 10 days after

14 submitting its final report pursuant to section 8.

15 SEC. 10. BUDGET COMPLIANCE.

16 Any spending authority (as defined in subparagraphs

17 (A) and (C) of section 401(c)(2) of the Congressional

18 Budget Act of 1974 (2 U.S.C. 651(c)(2)(A))) authorized

19 by this Act shall be effective only to such extent or in such

20 amounts as are provided in appropriation Acts.

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