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 Com-
merce, and in addition to the Committees on Ways and Means and Nat-
ural Resources, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To provide for comprehensive health insurance coverage for 
all United States residents, improved health care deliv-
ery, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘United States National Health Care Act or the Ex-
panded and Improved Medicare for All Act’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Definitions and terms. 
TITLE I—ELIGIBILITY AND BENEFITS 
Sec. 101. Eligibility and registration. 
Sec. 102. Benefits and portability. 
Sec. 103. Qualification of participating providers. 
Sec. 104. Prohibition against duplicating coverage. 
TITLE II—FINANCES 
Subtitle A—Budgeting and Payments 
Sec. 201. Budgeting process. 
Sec. 202. Payment of providers and health care clinicians. 
Sec. 203. Payment for long-term care. 
Sec. 204. Mental health services. 
Sec. 205. Payment for prescription medications, medical supplies, and medically 
necessary assistive equipment. 
Sec. 206. Consultation in establishing reimbursement levels. 
Subtitle B—Funding 
Sec. 211. Overview: funding the 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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SEC. 2. DEFINITIONS AND TERMS. 
In this Act: 
(1) USNHC PROGRAM; PROGRAM.—The terms 
‘‘USNHC Program’’ and ‘‘Program’’ mean the pro-
gram of benefits provided under this Act and, unless 
the context otherwise requires, the Secretary with 
respect to functions relating to carrying out such 
program. 
(2) NATIONAL BOARD OF UNIVERSAL QUALITY 
AND ACCESS.—The term ‘‘National Board of Uni-
versal Quality and Access’’ means such Board estab-
lished under section 305. 
(3) REGIONAL OFFICE.—The term ‘‘regional of-
fice’’ means a regional office established under sec-
tion 303. 
(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(5) DIRECTOR.—The term ‘‘Director’’ means, 
in relation to the Program, the Director appointed 
under section 301. 
TITLE I—ELIGIBILITY AND 
BENEFITS 
SEC. 101. ELIGIBILITY AND REGISTRATION. 
(a) IN GENERAL.—All individuals residing in the 
United States (including any territory of the United 
States) are covered under the USNHC Program entitling 
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them to a universal, best quality standard of care. Each 
such individual shall receive a card with a unique number 
in the mail. An individual’s social security number shall 
not be used for purposes of registration under this section. 
(b) REGISTRATION.—Individuals and families shall 
receive a United States National Health Insurance Card 
in the mail, after filling out a United States National 
Health Insurance application form at a health care pro-
vider. Such application form shall be no more than 2 pages 
long. 
(c) PRESUMPTION.—Individuals who present them-
selves for covered services from a participating provider 
shall be presumed to be eligible for benefits under this Act, 
but shall complete an application for benefits in order to 
receive a United States National Health Insurance Card 
and have payment made for such benefits. 
(d) RESIDENCY CRITERIA.—The Secretary shall pro-
mulgate a rule that provides criteria for determining resi-
dency for eligibility purposes under the USNHC Program. 
(e) COVERAGE FOR VISITORS.—The Secretary shall 
promulgate a rule regarding visitors from other countries 
who seek premeditated non-emergency surgical proce-
dures. Such a rule should facilitate the establishment of 
country-to-country reimbursement arrangements or self 
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pay arrangements between the visitor and the provider of 
care. 
SEC. 102. BENEFITS AND PORTABILITY. 
(a) IN GENERAL.—The health care benefits under 
this Act cover all medically necessary services, including 
at least the following: 
(1) Primary care and prevention. 
(2) Inpatient care. 
(3) Outpatient care. 
(4) Emergency care. 
(5) Prescription drugs. 
(6) Durable medical equipment. 
(7) Long-term care. 
(8) Palliative care. 
(9) Mental health services. 
(10) The full scope of dental services (other 
than cosmetic dentistry). 
(11) Substance abuse treatment services. 
(12) Chiropractic services. 
(13) Basic vision care and vision correction 
(other than laser vision correction for cosmetic pur-
poses). 
(14) Hearing services, including coverage of 
hearing aids. 
(15) Podiatric care. 
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