I 
109TH CONGRESS 
1ST SESSION 
H. R. 676
To provide for comprehensive health insurance coverage for all United States 
residents, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 8, 2005
Mr. CONYERS (for himself, Mr. KUCINICH, Mr. MCDERMOTT, and Mrs. 
CHRISTENSEN) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees 
on Ways and Means, Resources, and Veterans’ Affairs, for a period to 
be subsequently determined by the Speaker, in each case for consider-
ation 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, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘United States National Health Insurance Act (or the 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 USNHI Program. 
Sec. 212. Appropriations for existing programs for uninsured and indigent. 
TITLE III—ADMINISTRATION 
Sec. 301. Public administration; appointment of Director. 
Sec. 302. Quality and cost control. 
Sec. 303. Regional and State administration; employment of displaced clerical 
workers. 
Sec. 304. Confidential Electronic Patient Record System. 
Sec. 305. National Board of Universal Quality and Access. 
TITLE IV—ADDITIONAL PROVISIONS 
Sec. 401. Treatment of VA and IHS health programs. 
Sec. 402. Public health and prevention. 
Sec. 403. Reduction in health disparities. 
TITLE V—EFFECTIVE DATE 
Sec. 501. Effective date.
SEC. 2. DEFINITIONS AND TERMS. 
In this Act: 
(1) USNHI PROGRAM; PROGRAM.—The terms 
‘‘USNHI 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 USNHI Program entitling 
them to a universal, best quality standard of care. Each 
such individual shall receive a card with a unique number 
in the mail. An individual’s social security number shall 
not be used for purposes of registration under this section.
(b) REGISTRATION.—Individuals and families shall 
receive a United States National Health Insurance Card 
in the mail, after filling out a United States National 
Health Insurance application form at a health care 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. 
SEC. 102. BENEFITS AND PORTABILITY. 
(a) IN GENERAL.—The health insurance benefits 
under this Act cover all medically necessary services, in-
cluding—
(1) primary care and prevention; 
(2) inpatient care; 
(3) outpatient care; 
(4) emergency care; 
(5) prescription drugs; 
(6) durable medical equipment; 
(7) long term care; 
(8) mental health services;
(9) the full scope of dental services (other than 
cosmetic dentistry); 
(10) substance abuse treatment services; 
(11) chiropractic services; and 
(12) basic vision care and vision correction 
(other than laser vision correction for cosmetic pur-
poses). 
(b) PORTABILITY.—Such benefits are available 
through any licensed health care clinician anywhere in the 
United States that is legally qualified to provide the bene-
fits. 
(c) NO COST-SHARING.—No deductibles, copayments, 
coinsurance, or other cost-sharing shall be imposed with 
respect to covered benefits. 
SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS. 
(a) REQUIREMENT TO BE PUBLIC OR NON-PROF-
IT.—
(1) IN GENERAL.—No institution may be a par-
ticipating provider unless it is a public or not-for-
profit institution. 
(2) CONVERSION
OF
INVESTOR-OWNED
PRO-
VIDERS.—Investor-owned providers of care opting to 
participate shall be required to convert to not-for-
profit status.
(3) COMPENSATION
FOR
CONVERSION.—The 
owners of such investor-owned providers shall be 
compensated for the actual appraised value of con-
verted facilities used in the delivery of care. 
(4) FUNDING.—There are authorized to be ap-
propriated from the Treasury such sums as are nec-
essary to compensate investor-owned providers as 
provided for under paragraph (3). 
(5) REQUIREMENTS.—The conversion to a not-
for-profit health care system shall take place over a 
15-year period, through the sale of US Treasury 
Bonds. Payment for conversions under paragraph 
(3) shall not be made for loss of business profits, 
but may be made only for costs associated with the 
conversion of real property and equipment. 
(b) QUALITY STANDARDS.—
(1) IN GENERAL.—Health care delivery facili-
ties must meet regional and State quality and licens-
ing guidelines as a condition of participation under 
such program, including guidelines regarding safe 
staffing and quality of care. 
(2) LICENSURE REQUIREMENTS.—Participating 
clinicians must be licensed in their State of practice 
and meet the quality standards for their area of 
care. No clinician whose license is under suspension
or who is under disciplinary action in any State may 
be a participating provider. 
(c) PARTICIPATION OF HEALTH MAINTENANCE OR-
GANIZATIONS.—
(1) IN
GENERAL.—Non-profit health mainte-
nance organizations that actually deliver care in 
their own facilities and employ clinicians on a sala-
ried basis may participate in the program and re-
ceive global budgets or capitation payments as speci-
fied in section 202. 
(2) EXCLUSION OF CERTAIN HEALTH MAINTE-
NANCE ORGANIZATIONS.—Other health maintenance 
organizations, including those which principally con-
tract to pay for services delivered by non-employees, 
shall be classified as insurance plans. Such organiza-
tions shall not be participating providers, and are 
subject to the regulations promulgated by reason of 
section 104(a) (relating to prohibition against dupli-
cating coverage). 
(d) FREEDOM OF CHOICE.—Patients shall have free 
choice of participating physicians and other clinicians, 
hospitals, and inpatient care facilities.
SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE. 
(a) IN GENERAL.—It is unlawful for a private health 
insurer to sell health insurance coverage that duplicates 
the benefits provided under this Act. 
(b) CONSTRUCTION.—Nothing in this Act shall be 
construed as prohibiting the sale of health insurance cov-
erage for any additional benefits not covered by this Act, 
such as for cosmetic surgery or other services and items 
that are not medically necessary. 
TITLE II—FINANCES 
Subtitle A—Budgeting and 
Payments 
SEC. 201. BUDGETING PROCESS. 
(a) ESTABLISHMENT OF OPERATING BUDGET AND 
CAPITAL EXPENDITURES BUDGET.—
(1) IN GENERAL.—To carry out this Act there 
are established on an annual basis consistent with 
this title—
(A) an operating budget; 
(B) a capital expenditures budget; 
(C) reimbursement levels for providers con-
sistent with subtitle B; and 
(D) a health professional education budget, 
including amounts for the continued funding of 
resident physician training programs.
(2) REGIONAL
ALLOCATION.—After Congress 
appropriates amounts for the annual budget for the 
USNHI Program, the Director shall provide the re-
gional offices with an annual funding allotment to 
cover the costs of each region’s expenditures. Such 
allotment shall cover global budgets, reimbursements 
to clinicians, and capital expenditures. Regional of-
fices may receive additional funds from the national 
program at the discretion of the Director. 
(b) OPERATING BUDGET.—The operating budget 
shall be used for—
(1) payment for services rendered by physicians 
and other clinicians; 
(2) global budgets for institutional providers; 
(3) capitation payments for capitated groups; 
and 
(4) administration of the Program. 
(c) CAPITAL EXPENDITURES BUDGET.—The capital 
expenditures budget shall be used for funds needed for—
(1) the construction or renovation of health fa-
cilities; and 
(2) for major equipment purchases. 
(d) PROHIBITION AGAINST CO-MINGLING OPER-
ATIONS AND CAPITAL IMPROVEMENT FUNDS.—It is pro-
hibited to use funds under this Act that are earmarked—
(1) for operations for capital expenditures; or 
(2) for capital expenditures for operations. 
SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLI-
NICIANS. 
(a) ESTABLISHING GLOBAL BUDGETS; MONTHLY 
LUMP SUM.—
(1) IN
GENERAL.—The USNHI Program, 
through its regional offices, shall pay each hospital, 
nursing home, community or migrant health center, 
home care agencies, or other institutional provider 
or pre-paid group practice a monthly lump sum to 
cover all operating expenses under a global budget. 
(2) ESTABLISHMENT OF GLOBAL BUDGETS.—
The global budget of a provider shall be set through 
negotiations between providers and regional direc-
tors, but are subject to the approval of the Director. 
The budget shall be negotiated annually, based on 
past expenditures, projected changes in levels of 
services, wages and input, costs, and proposed new 
and innovative programs. 
(b) THREE PAYMENT OPTIONS FOR PHYSICIANS AND 
CERTAIN OTHER HEALTH PROFESSIONALS.—
(1) IN GENERAL.—The Program shall pay phy-
sicians, dentists, doctors of osteopathy, psycholo-
gists, chiropractors, doctors of optometry, nurse
practitioners, nurse midwives, physicians’ assistants, 
and other advanced practice clinicians as licensed 
and regulated by the States by the following pay-
ment methods: 
(A) Fee for service payment under para-
graph (2). 
(B) Salaried positions in institutions re-
ceiving global budgets under paragraph (3). 
(C) Salaried positions within group prac-
tices or non-profit health maintenance organiza-
tions receiving capitation payments under para-
graph (4). 
(2) FEE FOR SERVICE.—
(A) IN GENERAL.—The Program shall ne-
gotiate a simplified fee schedule that is fair 
with representatives of physicians and other cli-
nicians, after close consultation with the Na-
tional Board of Universal Quality and Access 
and regional and State directors. Initially, the 
current prevailing fees or reimbursement would 
be the basis for the fee negotiation for all pro-
fessional services covered under this Act. 
(B) 
CONSIDERATIONS.—In 
establishing 
such schedule, the Director shall take into con-
sideration regional differences in reimburse-