I 
115TH 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 24, 2017 
Mr. CONYERS (for himself, Mr. HUFFMAN, Ms. LEE, Ms. CLARK of Massachu-
setts, Mr. CLAY, Mr. CLYBURN, Mr. COHEN, Mr. CUMMINGS, Mr. ELLI-
SON, Mr. ENGEL, Mr. GRIJALVA, Ms. JACKSON LEE, Mr. TED LIEU of 
California, Ms. NORTON, Mr. POCAN, Ms. ROYBAL-ALLARD, Mr. RYAN 
of Ohio, Mr. SCOTT of Virginia, Mr. SERRANO, Mr. TAKANO, Ms. KAP-
TUR, Mr. JEFFRIES, Mr. LEWIS of Georgia, Mr. TONKO, Mr. THOMPSON 
of Mississippi, Ms. SCHAKOWSKY, Mrs. WATSON COLEMAN, Mr. WELCH, 
Mrs. NAPOLITANO, Mr. BRADY of Pennsylvania, Mr. CARTWRIGHT, Ms. 
PINGREE, Mrs. LAWRENCE, Mr. GARAMENDI, Ms. LOFGREN, Mr. BLU-
MENAUER, Ms. KELLY of Illinois, Ms. CLARKE of New York, Mr. NOLAN, 
Mr. CLEAVER, Mr. HASTINGS, Ms. JUDY CHU of California, Mr. MCGOV-
ERN, Mr. JOHNSON of Georgia, Mr. NADLER, Ms. JAYAPAL, Mr. MI-
CHAEL F. DOYLE of Pennsylvania, Ms. ADAMS, Mrs. BEATTY, Mr. AL 
GREEN of Texas, Mr. DESAULNIER, and Ms. MOORE) introduced the fol-
lowing 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. 
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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 
‘‘Expanded & 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 Medicare For All 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. 
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TITLE V—EFFECTIVE DATE 
Sec. 501. Effective date. 
SEC. 2. DEFINITIONS AND TERMS. 
In this Act: 
(1) MEDICARE FOR ALL PROGRAM; PROGRAM.— 
The terms ‘‘Medicare For All Program’’ and ‘‘Pro-
gram’’ mean the program 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. 
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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 Medicare For All 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 num-
ber shall not be used for purposes of registration under 
this section. 
(b) REGISTRATION.—Individuals and families shall 
receive a Medicare For All Program Card in the mail, 
after filling out a Medicare For All Program application 
form at a health care provider. 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 Medicare For All Program Card and have pay-
ment made for such benefits. 
(d) RESIDENCY CRITERIA.—The Secretary shall pro-
mulgate a rule that provides criteria for determining resi-
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dency for eligibility purposes under the Medicare For All 
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 
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) Approved dietary and nutritional therapies. 
(3) Inpatient care. 
(4) Outpatient care. 
(5) Emergency care. 
(6) Prescription drugs. 
(7) Durable medical equipment. 
(8) Long-term care. 
(9) Palliative care. 
(10) Mental health services. 
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(11) The full scope of dental services, services, 
including 
periodontics, 
oral 
surgery, 
and 
endodontics, but not including cosmetic dentistry. 
(12) Substance abuse treatment services. 
(13) Chiropractic services, not including elec-
trical stimulation. 
(14) Basic vision care and vision correction 
(other than laser vision correction for cosmetic pur-
poses). 
(15) Hearing services, including coverage of 
hearing aids. 
(16) Podiatric care. 
(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, copay-
ments, 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. Private physicians, private clinics, 
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and private health care providers shall continue to 
operate as private entities, but are prohibited from 
being investor owned. 
(2) CONVERSION
OF
INVESTOR-OWNED
PRO-
VIDERS.—For-profit providers of care opting to par-
ticipate shall be required to convert to not-for-profit 
status. 
(3) PRIVATE
DELIVERY
OF
CARE
REQUIRE-
MENT.—For-profit providers of care that convert to 
non-profit status shall remain privately owned and 
operated entities. 
(4) COMPENSATION
FOR
CONVERSION.—The 
owners of such for-profit providers shall be com-
pensated for reasonable financial losses incurred as 
a result of the conversion from for-profit to non- 
profit status. 
(5) 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). 
(6) REQUIREMENTS.—The payments to owners 
of converting for-profit providers shall occur during 
a 15-year period, through the sale of U.S. Treasury 
Bonds. Payment for conversions under paragraph 
(3) shall not be made for loss of business profits. 
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(7) MECHANISM FOR CONVERSION PROCESS.— 
The Secretary shall promulgate a rule to provide a 
mechanism to further the timely, efficient, and fea-
sible conversion of for-profit providers of care. 
(b) QUALITY STANDARDS.— 
(1) IN GENERAL.—Health care delivery facili-
ties must meet State quality and licensing 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 deliver care in their own 
facilities and employ clinicians on a salaried basis 
may participate in the program and receive global 
budgets or capitation payments as specified in sec-
tion 202. 
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(2) EXCLUSION OF CERTAIN HEALTH MAINTE-
NANCE ORGANIZATIONS.—Other health maintenance 
organizations which principally contract to pay for 
services delivered by non-employees shall be classi-
fied as insurance plans. Such organizations shall not 
be participating providers, and are subject to the 
regulations promulgated by reason of section 104(a) 
(relating to prohibition against duplicating cov-
erage). 
(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. 
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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, 
including 
amounts for optimal physician, nurse, and other 
health care professional staffing; 
(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 
Medicare For All Program, the Director shall pro-
vide the regional offices with an annual funding al-
lotment to cover the costs of each region’s expendi-
tures. Such allotment shall cover global budgets, re-
imbursements to clinicians, health professional edu-
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cation, and capital expenditures. Regional offices 
may receive additional funds from the national pro-
gram 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.— 
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(1) IN GENERAL.—The Medicare For All Pro-
gram, through its regional offices, shall pay each in-
stitutional provider of care, including hospitals, 
nursing homes, community or migrant health cen-
ters, home care agencies, or other institutional pro-
viders or pre-paid group practices, 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, State directors, and 
regional directors, but are subject to the approval of 
the Director. The budget shall be negotiated annu-
ally, based on past expenditures, projected changes 
in levels of services, wages and input, costs, a pro-
vider’s maximum capacity to provide care, and pro-
posed 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, pharmacists, 
psychologists, chiropractors, doctors of optometry, 
nurse practitioners, nurse midwives, physicians’ as-
sistants, and other advanced practice clinicians as li-
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censed and regulated by the States by the following 
payment 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 and 
optimal with representatives of physicians and 
other clinicians, after close consultation with 
the National Board of Universal Quality and 
Access and regional and State directors. Ini-
tially, the current prevailing fees or reimburse-
ment would be the basis for the fee negotiation 
for all professional services covered under this 
Act. 
(B) 
CONSIDERATIONS.—In 
establishing 
such schedule, the Director shall take into con-
sideration the following: 
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(i) The need for a uniform national 
standard. 
(ii) The goal of ensuring that physi-
cians, clinicians, pharmacists, and other 
medical professionals be compensated at a 
rate which reflects their expertise and the 
value of their services, regardless of geo-
graphic region and past fee schedules. 
(C) STATE PHYSICIAN PRACTICE REVIEW 
BOARDS.—The State director for each State, in 
consultation with representatives of the physi-
cian community of that State, shall establish 
and appoint a physician practice review board 
to assure quality, cost effectiveness, and fair re-
imbursements for physician delivered services. 
(D) FINAL
GUIDELINES.—The Director 
shall be responsible for promulgating final 
guidelines to all providers. 
(E) BILLING.—Under this Act physicians 
shall submit bills to the regional director on a 
simple form, or via computer. Interest shall be 
paid to providers who are not reimbursed within 
30 days of submission. 
(F) 
NO
BALANCE
BILLING.—Licensed 
health care clinicians who accept any payment 
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from the Medicare For All Program may not 
bill any patient for any covered service. 
(G) UNIFORM
COMPUTER
ELECTRONIC 
BILLING SYSTEM.—The Director shall create a 
uniform computerized electronic billing system, 
including those areas of the United States 
where electronic billing is not yet established. 
(3) SALARIES WITHIN INSTITUTIONS RECEIVING 
GLOBAL BUDGETS.— 
(A) IN GENERAL.—In the case of an insti-
tution, such as a hospital, health center, group 
practice, community and migrant health center, 
or a home care agency that elects to be paid a 
monthly global budget for the delivery of health 
care as well as for education and prevention 
programs, physicians and other clinicians em-
ployed by such institutions shall be reimbursed 
through a salary included as part of such a 
budget. 
(B) SALARY RANGES.—Salary ranges for 
health care providers shall be determined in the 
same way as fee schedules under paragraph (2). 
(4) SALARIES WITHIN CAPITATED GROUPS.— 
(A) IN GENERAL.—Health maintenance or-
ganizations, group practices, and other institu-
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tions may elect to be paid capitation payments 
to cover all outpatient, physician, and medical 
home care provided to individuals enrolled to 
receive benefits through the organization or en-
tity. 
(B) SCOPE.—Such capitation may include 
the costs of services of licensed physicians and 
other licensed, independent practitioners pro-
vided to inpatients. Other costs of inpatient and 
institutional care shall be excluded from capita-
tion payments, and shall be covered under insti-
tutions’ global budgets. 
(C) PROHIBITION OF SELECTIVE ENROLL-
MENT.—Patients shall be permitted to enroll or 
disenroll from such organizations or entities 
without discrimination and with appropriate no-
tice. 
(D) HEALTH
MAINTENANCE
ORGANIZA-
TIONS.—Under this Act— 
(i) health maintenance organizations 
shall be required to reimburse physicians 
based on a salary; and 
(ii) financial incentives between such 
organizations and physicians based on uti-
lization are prohibited. 
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SEC. 203. PAYMENT FOR LONG-TERM CARE. 
(a) ALLOTMENT FOR REGIONS.—The Program shall 
provide for each region a single budgetary allotment to 
cover a full array of long-term care services under this 
Act. 
(b) REGIONAL BUDGETS.—Each region shall provide 
a global budget to local long-term care providers for the 
full range of needed services, including in-home, nursing 
home, and community based care. 
(c) BASIS FOR BUDGETS.—Budgets for long-term 
care services under this section shall be based on past ex-
penditures, financial and clinical performance, utilization, 
and projected changes in service, wages, and other related 
factors. 
(d) FAVORING NON-INSTITUTIONAL CARE.—All ef-
forts shall be made under this Act to provide long-term 
care in a home- or community-based setting, as opposed 
to institutional care. 
SEC. 204. MENTAL HEALTH SERVICES. 
(a) IN GENERAL.—The Program shall provide cov-
erage for all medically necessary mental health care on 
the same basis as the coverage for other conditions. Li-
censed mental health clinicians shall be paid in the same 
manner as specified for other health professionals, as pro-
vided for in section 202(b). 
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(b) FAVORING
COMMUNITY-BASED
CARE.—The 
Medicare For All Program shall cover supportive resi-
dences, occupational therapy, and ongoing mental health 
and counseling services outside the hospital for patients 
with serious mental illness. In all cases the highest quality 
and most effective care shall be delivered, and, for some 
individuals, this may mean institutional care. 
SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, 
MEDICAL SUPPLIES, AND MEDICALLY NEC-
ESSARY ASSISTIVE EQUIPMENT. 
(a) NEGOTIATED PRICES.—The prices to be paid 
each year under this Act for covered pharmaceuticals, 
medical supplies, and medically necessary assistive equip-
ment shall be negotiated annually by the Program. 
(b) PRESCRIPTION DRUG FORMULARY.— 
(1) IN GENERAL.—The Program shall establish 
a prescription drug formulary system, which shall 
encourage best-practices in prescribing and discour-
age the use of ineffective, dangerous, or excessively 
costly medications when better alternatives are avail-
able. 
(2) PROMOTION OF USE OF GENERICS.—The 
formulary shall promote the use of generic medica-
tions but allow the use of brand-name and off-for-
mulary medications. 
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(3) FORMULARY
UPDATES
AND
PETITION 
RIGHTS.—The formulary shall be updated frequently 
and clinicians and patients may petition their region 
or the Director to add new pharmaceuticals or to re-
move ineffective or dangerous medications from the 
formulary. 
SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSE-
MENT LEVELS. 
Reimbursement levels under this subtitle shall be set 
after close consultation with regional and State Directors 
and after the annual meeting of National Board of Uni-
versal Quality and Access. 
Subtitle B—Funding 
SEC. 211. OVERVIEW: FUNDING THE MEDICARE FOR ALL 
PROGRAM. 
(a) IN GENERAL.—The Medicare For All Program 
is to be funded as provided in subsection (c)(1). 
(b) MEDICARE FOR ALL TRUST FUND.—There shall 
be established a Medicare For All Trust Fund in which 
funds provided under this section are deposited and from 
which expenditures under this Act are made. 
(c) FUNDING.— 
(1) IN GENERAL.—There are appropriated to 
the Medicare For All Trust Fund amounts sufficient 
to carry out this Act from the following sources: 
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(A) Existing sources of Federal Govern-
ment revenues for health care. 
(B) Increasing personal income taxes on 
the top 5 percent income earners. 
(C) Instituting a modest and progressive 
excise tax on payroll and self-employment in-
come. 
(D) Instituting a modest tax on unearned 
income. 
(E) Instituting a small tax on stock and 
bond transactions. 
(2) SYSTEM SAVINGS AS A SOURCE OF FINANC-
ING.—Funding otherwise required for the Program 
is reduced as a result of— 
(A) vastly reducing paperwork; 
(B) requiring a rational bulk procurement 
of medications under section 205(a); and 
(C) improved access to preventive health 
care. 
(3) ADDITIONAL ANNUAL APPROPRIATIONS TO 
MEDICARE FOR ALL PROGRAM.—Additional sums are 
authorized to be appropriated annually as needed to 
maintain maximum quality, efficiency, and access 
under the Program. 
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SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS. 
Notwithstanding any other provision of law, there are 
hereby transferred and appropriated to carry out this Act, 
amounts from the Treasury equivalent to the amounts the 
Secretary estimates would have been appropriated and ex-
pended for Federal public health care programs, including 
funds that would have been appropriated under the Medi-
care program under title XVIII of the Social Security Act, 
under the Medicaid program under title XIX of such Act, 
and under the Children’s Health Insurance Program 
under title XXI of such Act. 
TITLE III—ADMINISTRATION 
SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DI-
RECTOR. 
(a) IN GENERAL.—Except as otherwise specifically 
provided, this Act shall be administered by the Secretary 
through a Director appointed by the Secretary. 
(b) LONG-TERM CARE.—The Director shall appoint 
a director for long-term care who shall be responsible for 
administration of this Act and ensuring the availability 
and accessibility of high quality long-term care services. 
(c) MENTAL HEALTH.—The Director shall appoint a 
director for mental health who shall be responsible for ad-
ministration of this Act and ensuring the availability and 
accessibility of high quality mental health services. 
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SEC. 302. OFFICE OF QUALITY CONTROL. 
The Director shall appoint a director for an Office 
of Quality Control. Such director shall, after consultation 
with State and regional directors, provide annual rec-
ommendations to Congress, the President, the Secretary, 
and other Program officials on how to ensure the highest 
quality health care service delivery. The director of the Of-
fice of Quality Control shall conduct an annual review on 
the adequacy of medically necessary services, and shall 
make recommendations of any proposed changes to the 
Congress, the President, the Secretary, and other Medi-
care For All Program officials. 
SEC. 303. REGIONAL AND STATE ADMINISTRATION; EM-
PLOYMENT OF DISPLACED CLERICAL WORK-
ERS. 
(a) ESTABLISHMENT OF MEDICARE FOR ALL PRO-
GRAM REGIONAL OFFICES.—The Secretary shall establish 
and maintain Medicare For All regional offices for the 
purpose of distributing funds to providers of care. When-
ever possible, the Secretary should incorporate pre-exist-
ing Medicare infrastructure for this purpose. 
(b) APPOINTMENT OF REGIONAL AND STATE DIREC-
TORS.—In each such regional office there shall be— 
(1) one regional director appointed by the Di-
rector; and 
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(2) for each State in the region, a deputy direc-
tor (in this Act referred to as a ‘‘State Director’’) 
appointed by the governor of that State. 
(c) REGIONAL OFFICE DUTIES.—Regional offices of 
the Program shall be responsible for— 
(1) coordinating funding to health care pro-
viders and physicians; and 
(2) coordinating billing and reimbursements 
with physicians and health care providers through a 
State-based reimbursement system. 
(d) STATE DIRECTOR’S DUTIES.—Each State Direc-
tor shall be responsible for the following duties: 
(1) Providing an annual State health care needs 
assessment report to the National Board of Uni-
versal Quality and Access, and the regional board, 
after a thorough examination of health needs, in 
consultation with public health officials, clinicians, 
patients, and patient advocates. 
(2) Health planning, including oversight of the 
placement of new hospitals, clinics, and other health 
care delivery facilities. 
(3) Health planning, including oversight of the 
purchase and placement of new health equipment to 
ensure timely access to care and to avoid duplica-
tion. 
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(4) Submitting global budgets to the regional 
director. 
(5) Recommending changes in provider reim-
bursement or payment for delivery of health services 
in the State. 
(6) Establishing a quality assurance mechanism 
in the State in order to minimize both under utiliza-
tion and over utilization and to assure that all pro-
viders meet high quality standards. 
(7) Reviewing program disbursements on a 
quarterly basis and recommending needed adjust-
ments in fee schedules needed to achieve budgetary 
targets and assure adequate access to needed care. 
(e) FIRST
PRIORITY
IN
RETRAINING
AND
JOB 
PLACEMENT; 2 YEARS OF SALARY PARITY BENEFITS.— 
The Program shall provide that clerical, administrative, 
and billing personnel in insurance companies, doctors of-
fices, hospitals, nursing facilities, and other facilities 
whose jobs are eliminated due to reduced administration— 
(1) should have first priority in retraining and 
job placement in the new system; and 
(2) shall be eligible to receive two years of 
Medicare For All employment transition benefits 
with each year’s benefit equal to salary earned dur-
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ing the last 12 months of employment, but shall not 
exceed $100,000 per year. 
(f) ESTABLISHMENT OF MEDICARE FOR ALL EM-
PLOYMENT TRANSITION FUND.—The Secretary shall es-
tablish a trust fund from which expenditures shall be 
made to recipients of the benefits allocated in subsection 
(e). 
(g) ANNUAL APPROPRIATIONS TO MEDICARE FOR 
ALL EMPLOYMENT TRANSITION FUND.—Sums are au-
thorized to be appropriated annually as needed to fund 
the Medicare For All Employment Transition Benefits. 
(h) RETENTION OF RIGHT TO UNEMPLOYMENT BEN-
EFITS.—Nothing in this section shall be interpreted as a 
waiver of Medicare For All Employment Transition ben-
efit recipients’ right to receive Federal and State unem-
ployment benefits. 
SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD 
SYSTEM. 
(a) IN GENERAL.—The Secretary shall create a 
standardized, confidential electronic patient record system 
in accordance with laws and regulations to maintain accu-
rate patient records and to simplify the billing process, 
thereby reducing medical errors and bureaucracy. 
(b) PATIENT OPTION.—Notwithstanding that all bill-
ing shall be preformed electronically, patients shall have 
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the option of keeping any portion of their medical records 
separate from their electronic medical record. 
SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND 
ACCESS. 
(a) ESTABLISHMENT.— 
(1) IN GENERAL.—There is established a Na-
tional Board of Universal Quality and Access (in 
this section referred to as the ‘‘Board’’) consisting 
of 15 members appointed by the President, by and 
with the advice and consent of the Senate. 
(2) QUALIFICATIONS.—The appointed members 
of the Board shall include at least one of each of the 
following: 
(A) Health care professionals. 
(B) Representatives of institutional pro-
viders of health care. 
(C) Representatives of health care advo-
cacy groups. 
(D) Representatives of labor unions. 
(E) Citizen patient advocates. 
(3) TERMS.—Each member shall be appointed 
for a term of 6 years, except that the President shall 
stagger the terms of members initially appointed so 
that the term of no more than 3 members expires 
in any year. 
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(4) PROHIBITION
ON
CONFLICTS
OF
INTER-
EST.—No member of the Board shall have a finan-
cial conflict of interest with the duties before the 
Board. 
(b) DUTIES.— 
(1) IN
GENERAL.—The Board shall meet at 
least twice per year and shall advise the Secretary 
and the Director on a regular basis to ensure qual-
ity, access, and affordability. 
(2) SPECIFIC ISSUES.—The Board shall specifi-
cally address the following issues: 
(A) Access to care. 
(B) Quality improvement. 
(C) Efficiency of administration. 
(D) Adequacy of budget and funding. 
(E) Appropriateness of reimbursement lev-
els of physicians and other providers. 
(F) Capital expenditure needs. 
(G) Long-term care. 
(H) Mental health and substance abuse 
services. 
(I) Staffing levels and working conditions 
in health care delivery facilities. 
(3) ESTABLISHMENT
OF
UNIVERSAL, 
BEST 
QUALITY
STANDARD
OF
CARE.—The Board shall 
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specifically establish a universal, best quality of 
standard of care with respect to— 
(A) appropriate staffing levels; 
(B) appropriate medical technology; 
(C) design and scope of work in the health 
workplace; 
(D) best practices; and 
(E) salary level and working conditions of 
physicians, clinicians, nurses, other medical pro-
fessionals, and appropriate support staff. 
(4) TWICE-A-YEAR REPORT.—The Board shall 
report its recommendations twice each year to the 
Secretary, the Director, Congress, and the Presi-
dent. 
(c) COMPENSATION, ETC.—The following provisions 
of section 1805 of the Social Security Act shall apply to 
the Board in the same manner as they apply to the Medi-
care Payment Assessment Commission (except that any 
reference to the Commission or the Comptroller General 
shall be treated as references to the Board and the Sec-
retary, respectively): 
(1) Subsection (c)(4) (relating to compensation 
of Board members). 
(2) Subsection (c)(5) (relating to chairman and 
vice chairman). 
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(3) Subsection (c)(6) (relating to meetings). 
(4) Subsection (d) (relating to director and 
staff; experts and consultants). 
(5) Subsection (e) (relating to powers). 
TITLE IV—ADDITIONAL 
PROVISIONS 
SEC. 401. TREATMENT OF VA AND IHS HEALTH PROGRAMS. 
(a) VA HEALTH PROGRAMS.—This Act provides for 
health programs of the Department of Veterans’ Affairs 
to initially remain independent for the 10-year period that 
begins on the date of the establishment of the Medicare 
For All Program. After such 10-year period, the Congress 
shall reevaluate whether such programs shall remain inde-
pendent or be integrated into the Medicare For All Pro-
gram. 
(b) INDIAN HEALTH SERVICE PROGRAMS.—This Act 
provides for health programs of the Indian Health Service 
to initially remain independent for the 5-year period that 
begins on the date of the establishment of the Medicare 
For All Program, after which such programs shall be inte-
grated into the Medicare For All Program. 
SEC. 402. PUBLIC HEALTH AND PREVENTION. 
It is the intent of this Act that the Program at all 
times stress the importance of good public health through 
the prevention of diseases. 
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