I 
114TH 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 
FEBRUARY 3, 2015 
Mr. CONYERS (for himself, Ms. CLARK of Massachusetts, Mr. CUMMINGS, Mr. 
MICHAEL F. DOYLE of Pennsylvania, Ms. EDWARDS, Mr. ELLISON, Ms. 
CLARKE of New York, Mr. FARR, Mr. AL GREEN of Texas, Mr. GRI-
JALVA, Mr. HASTINGS, Mr. HONDA, Mr. JOHNSON of Georgia, Ms. LEE, 
Mr. LEWIS, Mr. MCDERMOTT, Mr. NADLER, Mr. NOLAN, Mr. POCAN, 
Mr. RUSH, Ms. SCHAKOWSKY, Ms. KAPTUR, Mr. DESAULNIER, Mr. 
SCOTT of Virginia, Mr. TAKANO, Mr. TONKO, Mr. WELCH, Ms. PINGREE, 
Ms. WILSON of Florida, Mr. YARMUTH, Mr. COHEN, Mr. ENGEL, Mr. 
SERRANO, Ms. NORTON, Ms. ROYBAL-ALLARD, Mr. CARTWRIGHT, Mr. 
GUTIE´RREZ, Mr. JEFFRIES, Mr. CLYBURN, Mr. BRADY of Pennsylvania, 
Mr. HUFFMAN, Ms. JACKSON LEE, Ms. MOORE, Mr. RANGEL, and Ms. 
BASS) 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 deter-
mined 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 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 
‘‘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. 
TITLE V—EFFECTIVE DATE 
Sec. 501. Effective date. 
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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. 
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 
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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-
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 
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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) 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. 
(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). 
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(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, 
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 
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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. 
(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, 
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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. 
(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). 
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(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, 
including 
amounts for optimal physician, nurse, and other 
health care professional staffing; 
(B) a capital expenditures budget; 
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