I
104TH CONGRESS
1ST SESSION
H. R. 16
To provide a program of national health insurance, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 4, 1995
Mr. DINGELL introduced the following bill; which was referred to the Commit-
tee on Commerce, and in addition to the Committee on Ways and Means,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of the
committee concerned
A BILL
To provide a program of national health insurance, and
for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
That this Act, with the following table of contents, may
be cited as the ‘‘National Health Insurance Act’’.
TABLE OF CONTENTS
Secs. 2–5. Declaration of purpose.
TITLE I—BENEFITS AND ELIGIBILITY
Sec. 101. Classes of personal health services.
Sec. 102. Availability of benefits.
Sec. 103. How benefits obtained; free choice by patient.
Sec. 104. Eligibility for benefits.
Sec. 105. Provision of benefits for noninsured needy and other individuals.
TITLE II—PARTICIPATION OF PHYSICIANS, DENTISTS, NURSES,
HOSPITALS, AND OTHERS
Sec. 201. Physicians and dentists; specialists.
Sec. 202. Nurses.
Sec. 203. Hospitals.
Sec. 204. Auxiliary services.
Sec. 205. Agreements with individual practitioners, hospitals, and others.
Sec. 206. Agreements with voluntary health insurance and other organizations.
Sec. 207. Provisions common to all agreements.
Sec. 208. Methods of payments for services.
Sec. 209. Amount of payments for services.
Sec. 210. Professional rights and responsibilities.
TITLE III—LOCAL ADMINISTRATION
Sec. 301. Decentralization of administration.
Sec. 302. Local administrative committee or officer.
Sec. 303. Local area committees.
Sec. 304. Local professional committees.
Sec. 305. Methods of administration.
TITLE IV—STATE ADMINISTRATION
Sec. 401. Declaration of policy.
Sec. 402. State plan of operations.
TITLE V—NATIONAL HEALTH INSURANCE BOARD; NATIONAL AD-
VISORY MEDICAL POLICY COUNCIL; GENERAL ADMINISTRATIVE
PROVISIONS
Sec. 501. National Health Insurance Board.
Sec. 502. Advisory Council.
Sec. 503. Studies, recommendations, and reports.
Sec. 504. Nondisclosure of information.
Sec. 505. Prohibition against discrimination.
TITLE VI—ELIGIBILITY DETERMINATIONS, COMPLAINTS,
HEARINGS, AND JUDICIAL REVIEW
Sec. 601. Determinations as to eligibility for benefits.
Sec. 602. Complaints of eligible individuals and of persons furnishing benefits.
TITLE VII—APPLICATION OF ACT TO INDIVIDUALS COVERED
UNDER MEDICARE PROGRAM
Sec. 701. Eligibility; benefits available.
Sec. 702. Study and report.
TITLE VIII—FISCAL PROVISIONS
Sec. 801. Personal health services account.
Sec. 802. Allotment of funds.
Sec. 803. Grants-in-aid for training and education.
TITLE IX—MISCELLANEOUS PROVISIONS
Sec. 901. Definitions.
Sec. 902. Effective date.
TITLE X—VALUE ADDED TAX AND NATIONAL HEALTH CARE
TRUST FUND
Sec. 1001. Imposition of value added tax.
Sec. 1002. Revenue from value added tax to fund National Health Care Trust
Fund.
TITLE XI—STUDY AND DEVELOPMENT OF COST CONTROL
MECHANISMS
Sec. 1101. Development of cost control mechanisms.
FINDINGS AND DECLARATION OF PURPOSE
SEC. 2. (a) The Congress finds that—
(1) the health of the Nation’s people is the
foundation of our Nation’s strength, productivity,
and wealth;
(2) the assurance of adequate medical care to
all of our people is essential to the general welfare
and to the Nation’s security;
(3) since the tremendous advances in medical
science in recent years have necessarily meant great
advances in the cost of health services, our archaic
system of paying for medical care—based on public
and private charity for the poor, on unpredictable
and often unbearable costs to the otherwise self-sup-
porting, and on disproportionate charges for the
well-to-do—has resulted in the following conditions:
(A) the inability of the vast majority of our
people to meet the shattering cost of serious or
chronic illness;
(B) the inability of most of our people to
benefit from modern preventive medicine; and
(C) wholly inadequate provision for the
health needs of our farm families and agricul-
tural workers;
(4) the conditions described in the preceding
paragraph cannot effectively be remedied under the
present system of payment for medical care, or
under any voluntary insurance system; and
(5) a medical dole as an answer to this problem
is repugnant to the American people and would cer-
tainly result in a system of state medicine, paid for
from tax funds and rendered by regimented doctors.
(b) The Congress declares the purposes of this Act
to be to provide a sound economic foundation for our free
system of medicine and to correct the maldistribution of
health personnel and facilities by establishing a system of
prepaid personal health insurance on the principle of social
insurance.
SEC. 3. In establishing a system of national health
insurance, it is the policy of this Act that those persons
and their dependents who are insured under the provisions
of the Act shall be assured full freedom to choose their
physicians and to change their choice as they may desire;
that physicians and other professions furnishing services
in accordance with the provisions of this Act shall be as-
sured full freedom in the practice of their professions, in-
cluding the right to accept or reject patients except as this
right may be restricted by their own professional ethics
or by the laws of the several States; and that the adminis-
tration of this Act shall be based upon the American prin-
ciple of decentralization.
SEC. 4. In carrying out these policies, it is the inten-
tion of Congress that the major administrative responsibil-
ities be placed in the hands of local bodies representing
both those who pay for and receive services and those who
render services, and operating within the framework of
plans made by the several States, and approved by the
Federal agency; that the National Health Care Trust
Fund created by this Act shall be allotted equitably among
the several States and by the States to their local areas;
that voluntary as well as governmental organizations shall
be recognized and utilized; and that all eligible individuals
and their dependents as specified in this Act shall be enti-
tled to its benefits without discrimination because of race,
color, or creed.
TITLE I—BENEFITS AND ELIGIBILITY
CLASSES OF PERSONAL HEALTH SERVICES
SEC. 101. (a) The personal health services to be made
available as benefits to eligible individuals as provided in
this title are medical services, dental services, podiatric
services, home-nursing services, hospital services, and aux-
iliary services. Each class of services shall be provided by
persons (including individuals, partnerships, corporations,
associations, consumer cooperatives, and other organiza-
tions) who are authorized by applicable State law, and who
are qualified under title II of this Act, to do so.
(b) Medical services consist of (1) general medical
services such as can be rendered by a physician engaged
in the general or family practice of medicine, including
preventive, diagnostic, and therapeutic care and periodic
medical examinations; and (2) specialist services rendered
by a physician who is a specialist in the class of services
rendered, as defined in section 201 of this Act. Such
services may be rendered at the office, home, hospital,
or elsewhere, as necessary.
(c) Dental services consist of (1) general dental serv-
ices rendered by a dentist engaged in the general practice
of dentistry, including preventive, diagnostic, and thera-
peutic care, and periodic dental examinations; and (2) spe-
cialist services rendered by a dentist who is a specialist
in the class of services rendered, as defined in section 201
of this Act. Such services may be rendered at the office,
home, hospital, or elsewhere, as necessary.
(d) Podiatric services consist of those professional
services of a podiatrist who is legally authorized to per-
form such services in the State in which he practices.
(e) Home-nursing services consist of nursing care of
the sick rendered in the home by a registered professional
nurse or a qualified practical nurse.
(f) Hospital services consist of hospitalization, includ-
ing necessary nursing services, and such physician, labora-
tory, ambulance, and other services in connection with
hospitalization as the National Health Insurance Board
(hereinafter in this Act referred to as the ‘‘Board’’), after
consultation with the National Advisory Medical Policy
Council (hereinafter in this Act referred to as the ‘‘Advi-
sory Council’’), by regulation designates as essential to
good hospital care, for a maximum of sixty days in any
benefit year; but hospital services shall not include hos-
pitalization in a mental disease hospital or institution, or
hospitalization for any day more than thirty days following
the diagnosis of a psychosis. Whenever the Board, after
consultation with the Advisory Council, finds that moneys
in the account (established by section 701) are adequate
and that facilities are available, it may by regulation in-
crease the maximum days of hospitalization in any benefit
year.
(g) Auxiliary services consist of such chemical, bac-
teriological, pathological, diagnostic X-ray and related lab-
oratory services; X-ray, radium, and related therapy; phys-
iotherapy; services of optometrists; and prescribed drugs
which are unusually expensive, special appliances, and eye-
glasses; as the Board, after consultation with the Advisory
Council, by regulation designates as auxiliary services on
the basis of its finding that their provision under this Act
is practicable and is essential to good health care.
AVAILABILITY OF BENEFITS
SEC. 102. (a) Medical services, hospital services, and,
except as otherwise provided in subsection (b) of this sec-
tion, all other personal health services specified in section
101 shall be made available (subject to section 701) as
benefits to eligible individuals in all health-service areas
within the United States as rapidly and as completely as
possible having regard for the availability of the profes-
sional and technical personnel and the hospital and other
facilities needed to provide such services. To this end the
resources and needs of each State shall be surveyed and
a program developed in each State to assure the maximum
participation and use of health personnel and facilities in
the provision of benefits, and to encourage improvement
in the number and distribution of such personnel and fa-
cilities throughout the State. Additional surveys shall be
undertaken as required, and the program in the State
from time to time modified on the basis thereof.
(b) If the Board, after consultation with the Advisory
Council, finds that the personnel or facilities or funds that
are or can be made available are inadequate to insure the
provision of all services included as dental, home-nursing,
or auxiliary services under section 101 of this Act, it may
by regulation limit for a specified period the services which
may be provided as benefits, or modify the extent to which,
or the circumstances under which, they will be provided
to eligible individuals. Any such restriction or limitation
shall be reduced or withdrawn as rapidly as may be prac-
ticable; and, in the case of dental services, priority in the
reduction or withdrawal of any such restriction or limita-
tion shall be given to children.
(c) The Board shall have the duty of studying and
making recommendations as to needed services and facili-
ties for the care of the chronic sick afflicted with physical
ailments, and for the care of individuals afflicted with
mental or nervous diseases, and as to needed provisions
for the prevention of chronic physical diseases and of men-
tal or nervous diseases; and of making reports from time
to time, with recommendations as to legislation, but the
first such report shall be made not later than two years
after benefits under this Act first become available.
HOW BENEFITS OBTAINED: FREE CHOICE BY PATIENT
SEC. 103. Every individual eligible for personal
health services available under this Act may freely select
the physician, dentist, podiatrist, nurse, medical group,
hospital, or other person of his choice to render such serv-
ices, and may change such selection if the practitioner,
medical group, hospital, or other person has agreed under
title II of this Act to furnish the class of services required
and consents to furnish such services to the individual.
General medical, dental, and podiatric services may be ob-
tained by request made by the individual directly to the
practitioner of the individual’s choice. Specialist, home-
nursing, hospital, and auxiliary services shall be obtained
from the specialist, nurse, hospital, or other person of the
individual’s choice, whenever the practitioner from whom
he is receiving medical or dental services as benefits under
this Act refers him for specialist, home-nursing, hospital,
or auxiliary services upon determining that such services
are required in the proper care of his particular case; or
whenever, upon request of the individual, an administra-
tive medical officer, upon a like determination, refers him
for such services. The Board, by regulation, shall dispense
with the necessity of referral in cases of emergency, and
may dispense with the necessity of referral under specified
circumstances or as respects specified classes of services,
or both, if it finds, after consultation with the Advisory
Council, that such action will be conducive to the provision
of a more adequate amount and quality of health care and
will not unreasonably increase the expenditures from the
account for such services.
ELIGIBILITY FOR BENEFITS
SEC. 104. (a) Subject to section 701, every individual
shall be eligible for benefits under this Act throughout any
benefit year if—
(1) he has received (or, in the case of income
from self-employment, has accrued)—
(A) not less than $2,000 in wages during
the first four of the last six calendar quarters
preceding the beginning of the benefit year; or
(B) not less than $1,500 in wages in each
of six calendar quarters during the first twelve
of the last fourteen calendar quarters preceding
the beginning of the benefit year (not counting
as one of such fourteen calendar quarters any
quarter in any part of which the individual was
under a total disability which continued for six
months or more);
(2) he is entitled, for the first month in the
benefit year, to a benefit under title II of the Social
Security Act or to an annuity under subchapter III
(relating to civil service retirement) of chapter 83 of
title 5, United States Code; or
(3) he is on the first day of the benefit year a
dependent of an individual who is eligible under
paragraph (1) or paragraph (2).
(b) Subject to section 701, every individual, not eligi-
ble therefor under subsection (a), shall be eligible for bene-
fits under this Act during the remainder of a benefit year,
beginning with—
(1) the first day of any calendar quarter in
such benefit year, if he has received (or, in the case
of income from self-employment, has accrued) not
less than $150 in wages during the first four of the
last six calendar quarters preceding the beginning of
such calendar quarter;
(2) the first day of the first month in such ben-
efit year for which he is entitled to a benefit or an-
nuity referred to in subsection (a)(2); or
(3) the first day in such benefit year on which
he is or becomes a dependent of an individual who
is eligible for benefits under subsection (a) (1) or (2)
under paragraph (1) or (2) of this subsection.
(c) No individual shall be deemed eligible for any per-
sonal health services as a benefit under this Act which
are required by reason of any injury, disease, or disability