I 
108TH CONGRESS 
2D SESSION 
H. R. 4325 
To guarantee for all Americans quality, affordable, and comprehensive health 
insurance coverage. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 11, 2004 
Ms. 
BALDWIN
(for 
herself, 
Mr. 
TIERNEY, 
Mr. 
MCDERMOTT, 
Ms. 
SCHAKOWSKY, Mr. GRIJALVA, Mr. CONYERS, Ms. LEE, Ms. JACKSON- 
LEE of Texas, and Mr. OBEY) introduced the following bill; which was 
referred to the Committee on Energy and Commerce, and in addition to 
the Committee on Ways and Means, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To guarantee for all Americans quality, affordable, and 
comprehensive health insurance coverage. 
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 
‘‘Health Security for All Americans Act’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
the Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings.
TITLE I—HEALTH SECURITY FOR ALL AMERICANS—EXPANSION 
PHASE (PHASE I) 
Sec. 101. Expansion phase (phase I) voluntary State universal health insurance 
coverage plans. 
‘‘TITLE XXII—HEALTH SECURITY FOR ALL AMERICANS 
‘‘PART A—EXPANSION PHASE (PHASE I) PLANS 
‘‘Sec. 2201. Purpose; voluntary State plans. 
‘‘Sec. 2202. Plan requirements. 
‘‘Sec. 2203. Coverage requirements for expansion phase (phase I) plans. 
‘‘Sec. 2204. Allotments. 
‘‘Sec. 2205. Administration. 
‘‘Sec. 2206. Definitions.’’. 
TITLE II—HEALTH SECURITY FOR ALL AMERICANS—UNIVERSAL 
PHASE (PHASE II) 
Sec. 201. Universal phase (phase II) State universal health insurance coverage 
plans. 
‘‘PART B—UNIVERSAL PHASE (PHASE II) PLANS 
‘‘Sec. 2211. Purpose; mandatory State plans. 
‘‘Sec. 2212. Plan requirements. 
‘‘Sec. 2213. Coverage requirements for universal phase (phase II) plans. 
‘‘Sec. 2214. Requirements for employers regarding the provision of bene-
fits. 
‘‘Sec. 2215. Allotments. 
‘‘Sec. 2216. Administration; definitions. 
Sec. 202. Consumer protections. 
‘‘PART C—CONSUMER PROTECTIONS 
‘‘Sec. 2221. Home care standards. 
‘‘Sec. 2222. Consumer protection in the event of termination or suspension 
of services. 
‘‘Sec. 2223. Consumer protection through disclosure of information. 
‘‘Sec. 2224. Consumer protection through notice of changes in health care 
delivery. 
TITLE III—PATIENT PROTECTIONS 
Sec. 301. Incorporation of certain protections. 
TITLE IV—HEALTH CARE QUALITY, PATIENT SAFETY, AND 
WORKFORCE STANDARDS 
Sec. 401. Health Care Quality, Patient Safety, and Workforce Standards Insti-
tute. 
Sec. 402. Health Care Quality, Patient Safety, and Workforce Standards Advi-
sory Committee. 
TITLE V—IMPROVING MEDICARE BENEFITS 
Sec. 501. Full mental health and substance abuse treatment benefits parity.
(7) In the United States, personal health care 
spending grows 2.5 percent faster than the gross do-
mestic product. 
(8) Although the United States spends consid-
erably more in health care per person than any other 
nation, it ranks only fifteenth among countries 
worldwide on an overall index designed to measure 
a range of health goals according to the World 
Health Organization. 
(9) One of 4 adults, about 40,000,000 people, 
say they have gone without needed medical care be-
cause they couldn’t afford it. 
(10) Nearly 31,000,000 Americans face collec-
tion agencies annually because they owe money for 
medical bills. 
(11) The average American worker is paying 
twice as much for family coverage than 10 years 
ago. 
(12) Because many individuals do not have 
health insurance coverage, they may incur health 
care costs which they do not fully reimburse, result-
ing in cost-shifting to others. 
(13) As a consequence of the piecemeal health 
care system in the United States, administrative 
overhead costs approximately $1,059 per person an-
nually, while other Western industrialized nations 
with universal health care systems spend approxi-
mately $200 per person annually for administrative 
overhead. 
(14) The United States should adopt national 
goals of universal, affordable, comprehensive health 
insurance coverage and should provide generous 
matching grants to the States to achieve those goals 
within 5 years of the date of enactment of this Act. 
TITLE I—HEALTH SECURITY FOR 
ALL AMERICANS—EXPANSION 
PHASE (PHASE I) 
SEC. 101. EXPANSION PHASE (PHASE I) VOLUNTARY STATE 
UNIVERSAL HEALTH INSURANCE COVERAGE 
PLANS. 
The Social Security Act (42 U.S.C. 301 et seq.) is 
amended by adding at the end the following: 
‘‘TITLE XXII—HEALTH SECURITY 
FOR ALL AMERICANS 
‘‘PART A—EXPANSION PHASE (PHASE I) PLANS 
‘‘SEC. 2201. PURPOSE; VOLUNTARY STATE PLANS. 
‘‘(a) PURPOSE.—The purpose of this part is to pro-
vide funds to participating States to enable those States 
to ensure universal health insurance coverage by estab-
lishing State administered systems targeted to State resi-
dents with a family income that does not exceed 300 per-
cent of the poverty line. 
‘‘(b) EXPANSION
PHASE
(PHASE
I) PLAN
RE-
QUIRED.—A State is not eligible for a payment under sec-
tion 2205(a) unless the State has submitted to the Sec-
retary a plan that— 
‘‘(1) sets forth how the State intends to use the 
funds provided under this part to ensure universal, 
affordable, and comprehensive health insurance cov-
erage to eligible residents of the State consistent 
with the provisions of this part; and 
‘‘(2) has been approved under section 2202(d). 
‘‘SEC. 2202. PLAN REQUIREMENTS. 
‘‘(a) IN GENERAL.—Every expansion phase (phase I) 
plan shall include provisions for the following: 
‘‘(1) INFORMATION ON THE LEVEL OF HEALTH 
INSURANCE COVERAGE.— 
‘‘(A) The level of health insurance coverage 
within the State as determined under sub-
section (b). 
‘‘(B) The base coverage gap for the year 
involved as determined under subsection (b)(4). 
‘‘(C) State efforts to provide or obtain 
health insurance coverage for uncovered resi-
dents of the State, including the steps the State
is taking to identify and enroll all uncovered 
residents of the State who are eligible to par-
ticipate in public or private health insurance 
programs. 
‘‘(2) DETAILS OF, AND TIMELINES FOR, EXPAN-
SION PHASE (PHASE I) PLAN.— 
‘‘(A) USE
OF
FUNDS; COORDINATION.— 
The activities that the State intends to carry 
out using funds received under this part, in-
cluding how the State will coordinate efforts 
under this part with existing State efforts to in-
crease the health insurance coverage of individ-
uals. 
‘‘(B) TIMELINES.—Consistent with sub-
section (c), the manner in which the State will 
reduce the base coverage gap for the year in-
volved, including a timetable with specified tar-
gets for reducing the base coverage gap by— 
‘‘(i) 50 percent within 2 years after 
the date of approval of the expansion 
phase (phase I) plan; and 
‘‘(ii) 100 percent within 4 years after 
such date. 
‘‘(3) MAINTENANCE OF EFFORT.—The manner 
in which the State will ensure that—
‘‘(A) employers within the State will con-
tinue to provide not less than the level of finan-
cial support toward the health insurance pre-
miums required for coverage of their employees 
as such employers provided as of the date of en-
actment of this title; and 
‘‘(B) the State will continue to provide not 
less than the level of State expenditures in-
curred for State-funded health programs as of 
such date. 
For purposes of this paragraph, any population or 
service that was covered under the medicaid pro-
gram under title XIX under a waiver under section 
1115 or section 1902(r)(2) shall be treated as if 
such State expenditures had been based on the en-
hanced FMAP formula used under the State chil-
dren’s health insurance program under title XXI. 
‘‘(4) STATE OUTREACH PROGRAMS; ACCESS.— 
The manner in which, and a timetable for when, the 
State will— 
‘‘(A) institute outreach programs; and 
‘‘(B) ensure that all eligible residents of 
the State have access to the health insurance 
coverage provided under this part.
‘‘(5) ASSURANCE OF COVERAGE OF ESSENTIAL 
SERVICES.—An assurance that the State program 
established under this part will comply with the re-
quirements of section 1867 (commonly referred to as 
the ‘Emergency Medical Treatment and Active 
Labor Act’). 
‘‘(6) REPRESENTATION ON BOARDS AND COM-
MISSIONS.—The manner in which the State will en-
sure that all Boards and Commissions that the State 
establishes to administer the plan will include, 
among others, representatives of providers, con-
sumers, employers, and health worker unions. 
‘‘(7) DISCLOSURE
OF
INFORMATION
TO
THE 
PUBLIC.—The manner in which the State will ensure 
that, with respect to entities and individuals that 
provide services for which reimbursement is provided 
under this part— 
‘‘(A) financial arrangements between in-
surers and providers and between providers and 
medical equipment suppliers are disclosed to the 
public; and 
‘‘(B) ownership interests and health care 
worker qualifications and credentials are dis-
closed to the public.