(C) LIMITATION ON DISCHARGE IN BANK-
RUPTCY.—Any obligation of an individual under 
this subtitle for payment of damages may be re-
leased by a discharge in bankruptcy under title 
11 of the United States Code only if such dis-
charge is granted after the expiration of the 5- 
year period beginning on the first date that 
payment of such damages is required. 
(b) PERIODIC REASSESSMENT
OF WORKER RA-
TIOS.—The National Health Board shall periodically as-
sess the ratio of the number of health workers employed 
by the Board in each job category (established under sub-
title A) in an area to the number of residents in the area. 
(c) WORKER MATCHES.—The National Health Board 
shall establish a program to match the locational pref-
erences of graduates of schools with the needs and pref-
erences of regions. 
SEC. 313. PAYMENT FOR CERTAIN EDUCATIONAL LOANS. 
(a) LOAN PAYMENT PROGRAM.—In the case of any 
individual who has incurred any educational loan before 
the fourth year after the effective date of health services 
and for the individual’s costs for an educational program 
in health care delivery, health care specialties, or health 
science specialty fields, the National Health Board shall 
make payments, in accordance with subsection (b), for and 
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on behalf of that individual, on the principal of and inter-
est on any such loan which is outstanding on the date the 
individual begins to work for the Service. 
(b) MAKING OF PAYMENT.—The payments described 
in subsection (a) shall be made by the National Health 
Board as follows: 
(1) Upon completion by the individual for whom 
the payments are to be made of the first year of em-
ployment with the Service, the National Health 
Board shall pay 30 percent of the principal of, and 
the interest on, each loan described in subsection (a) 
which is outstanding on the date he began such em-
ployment. 
(2) Upon completion by that individual of the 
second year of such employment, the National 
Health Board shall pay another 30 percent of the 
principal of, and the interest on, each such loan. 
(3) Upon completion by that individual of a 
third year of such employment, the National Health 
Board shall pay another 25 percent of the principal 
of, and the interest on, each such loan. 
(4) Upon completion by that individual of a 
fourth year of such employment, the National 
Health Board shall pay the remaining 15 percent of 
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the principal of, and all remaining interest on, each 
such loan. 
No payment may be made under this subsection with re-
spect to a loan unless the person on whose behalf the pay-
ment is to be made has submitted to the National Health 
Board a certified copy of the agreement under which such 
loan was made. 
(c) PAYMENT
DURING
EMPLOYMENT.—Notwith-
standing the requirement of completion of employment 
specified in subsection (b), the National Health Board 
shall on or before the due date thereof, pay any loan or 
loan installment which may fall due within the period of 
employment for which the borrower may receive payments 
under this section, upon the declaration of such borrower, 
at such times and in such manner as the National Health 
Board may prescribe (and supported by such other evi-
dence as the National Health Board may reasonably re-
quire), that the borrower is then employed as described 
in subsection (b) and that the borrower will continue to 
be so engaged for the period required (in the absence of 
this subsection) to entitle the borrower to have made the 
payments provided by this section for such period, except 
that not more than 85 percent of the principal of any such 
loan shall be paid pursuant to this subsection. 
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Subtitle 
C—Employment 
and 
Labor-Management 
Relations 
Within the Service 
SEC. 321. EMPLOYMENT, TRANSFER, PROMOTION, AND RE-
CEIPT OF FEES. 
(a) SERVICE EMPLOYEES.—The National Health 
Board shall employ, classify, and fix the salaries and bene-
fits of all employees of the Service employed in the Serv-
ice’s facilities. 
(b) POLICIES.—The National Health Board, in estab-
lishing guidelines and standards under this subtitle, shall, 
to the extent feasible and consistent with the provisions 
of this subtitle, provide for— 
(1) employment and promotion in the Service in 
the same manner as is provided for employment and 
promotion under the Federal civil service system; 
(2) meaningful opportunities for career ad-
vancement; 
(3) encouragement of health workers to use up 
to 10 percent of their work time for continuing edu-
cation under subtitle B without loss of pay or other 
job rights; and 
(4) full protection of employees’ rights by pro-
viding an opportunity for a fair hearing on adverse 
actions with representation of their own choosing. 
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(c) HIRING PREFERENCES.—The National Health 
Board, in hiring for employees to fill vacancies in newly 
created positions, shall give preference to individuals who 
were employed as health workers, or self-employed while 
delivering health services, before the date of enactment of 
this Act. The National Health Board shall ensure, through 
such steps as it deems necessary, that all such individuals 
desiring to be employed within the Service shall find ap-
propriate employment in the Service. 
(d) PROMOTION AND TRANSFER.—Employees of the 
Service shall be eligible for promotion or transfer to any 
position in the Service for which they are qualified. A job 
placement service in each region shall assist health work-
ers in its region in identifying suitable employment oppor-
tunities and in transferring between jobs. The authority 
given by this subsection shall be used to provide a max-
imum degree of career opportunities for employees and to 
ensure continued improvement of health care services. 
(e) NO UNDUE FINANCIAL INCENTIVES.—No health 
worker should benefit financially from the provision or de-
nial of services to individual patients, beyond their regular 
remuneration. 
(f) SOLE EMPLOYER.—An employee of the Service 
may not receive any fee or perquisite on account of duties 
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performed by virtue of such employment except from the 
Service. 
(g) GRANDFATHER CLAUSE.—The National Health 
Board shall support alternative procedures to assure that 
health care professionals meet required standards, par-
ticularly those currently practicing in health professional 
shortage areas in inner cities and in rural communities. 
(h) TRANSITIONAL EMPLOYMENT.—Up to 1 percent 
of the budget of the United States Health Service for each 
of its first 2 years may be expended for the retraining 
and hiring of sales, administrative, clerical, and service 
employees displaced as a result of this Act, including those 
in the health insurance industry. 
SEC. 322. APPLICABILITY OF LAWS RELATING TO FEDERAL 
EMPLOYEES. 
(a) IN GENERAL.—Chapter 75 of title 5, United 
States Code (relating to adverse actions against employ-
ees), apply to employees of the Service (other than employ-
ees serving on the personal staff of members of health 
boards) except to the extent provided— 
(1) in a collective bargaining agreement nego-
tiated on behalf of and applicable to them; or 
(2) in procedures established by the Service and 
approved by the Office of Personnel Management. 
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(b) COVERAGE UNDER WORKERS COMPENSATION.— 
Employees of the Service are covered by subchapter I of 
chapter 81 of title 5, United States Code (relating to com-
pensation for work injuries). 
(c) CIVIL SERVICE.— 
(1) APPLICATION
OF
CIVIL
SERVICE
RETIRE-
MENT.—Chapter 83 of title 5, United States Code 
(relating to civil service retirement), applies to em-
ployees of the Service except to the extent provided 
in a collective bargaining agreement negotiated on 
behalf of and applicable to them. 
(2) WITHHOLDING.—The Service shall withhold 
from pay and shall pay into the Civil Service Retire-
ment and Disability Fund the amounts specified in 
chapter 83 of title 5, United States Code, as re-
quired under paragraph (1). The Service, upon re-
quest of the Office of Personnel Management, but 
not less frequently than annually, shall pay to the 
Office the costs reasonably related to the adminis-
tration of Fund activities for employees of the Serv-
ice. 
(d) ACCRUAL OF SICK AND ANNUAL LEAVE.—Sick 
and annual leave and compensatory time of employees of 
the Service, whether accrued prior to or after the com-
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mencement of operations of the Service, shall be obliga-
tions of the Service. 
(e) APPLICATION OF CONDITIONS.— 
(1) TERMS OF EMPLOYMENT.—Compensation, 
benefits, and other terms and conditions of employ-
ment in effect on the effective date of health services 
for employees of the Federal Government performing 
functions that are provided under this Act by the 
Service, shall apply to all employees of the Service 
performing similar functions until changed by the 
Service in accordance with this Act. Subject to the 
provisions of this Act, the provisions of subchapter 
I of chapter 85 and chapter 87 of title 5, United 
States Code (relating to unemployment compensa-
tion and life insurance), apply to employees of the 
Service unless varied, added to, or substituted for in 
accordance with paragraph (2). 
(2) LIMITATION ON VARIATION.—No variation, 
addition, or substitution with respect to fringe bene-
fits shall result in a program of fringe benefits which 
on the whole is less favorable to employees of the 
Service than fringe benefits in effect for employees 
of the Federal Government on the effective date of 
health services. No variation, addition, or substi-
tution with respect to fringe benefits of employees 
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for whom there is a collective bargaining representa-
tive shall be made except by agreement between such 
representative and the Service. 
SEC. 323. APPLICABILITY OF FEDERAL LABOR-MANAGE-
MENT RELATIONS LAWS. 
(a) APPLICATION OF NLRA.— 
(1) IN GENERAL.—The provisions of the Na-
tional Labor Relations Act (42 U.S.C. 141 et seq.) 
shall apply to the Service and its employees to the 
extent, not inconsistent with subsection (b), to which 
such provisions apply to employers (as defined in 
section 2(2) of such Act), except that— 
(A) the phrase ‘‘or any individual employed 
as a supervisor’’ in section 2(3) of such Act 
shall not apply (thereby making such Act apply, 
for these purposes, to such individuals); 
(B) section 9(b)(1) of such Act (providing 
for separate treatment for professional and 
nonprofessional employees) shall not apply; 
(C) sections 206 through 210 of such Act 
(relating to national emergencies) shall, for pur-
poses of this Act, have the phrases ‘‘the Presi-
dent of the United States’’ and ‘‘the Presi-
dent’’, wherever they appear, replaced by the 
phrase ‘‘the National Health Board (or a com-
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mittee thereof to which it has delegated such 
authority)’’ and the phrase ‘‘national health or 
safety’’ replaced by the phrase ‘‘health or safety 
of the residents of any region’’; and 
(D) section 213 (providing for intervention 
in a strike or lockout by the Director of the 
Federal Mediation and Conciliation Service) 
shall not apply. 
(2) STRIKES PERMITTED.—Paragraphs (3) and 
(4) of section 7311 of title 5, United States Code 
(prohibiting participation in a strike or an organiza-
tion asserting the right to strike), shall not apply to 
employees of the Service. 
(b) NEUTRALITY
IN UNION MATTERS.—The Na-
tional Health Board shall adopt as a matter of general 
policy that governing boards at each level of the Service, 
and employers acting as agents of these boards, agree to 
determine employee preference on the subject of labor 
union representation, and to determine which one if union 
representation is preferred, by a card check procedure con-
ducted by a neutral third party in lieu of a formal election. 
(c) COLLECTIVE BARGAINING.— 
(1) IN GENERAL.—Collective bargaining agree-
ments between the National Health Board and duly 
recognized bargaining representatives of employees 
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of the Service may include procedures for resolution 
by the parties of grievances and adverse actions aris-
ing under the agreement, including procedures cul-
minating in binding third party arbitration. 
(2) ALTERNATIVE PROCEDURES.—The National 
Health Board and duly recognized bargaining rep-
resentatives of employees of the Service may by mu-
tual agreement adopt procedures for the resolution 
by the parties— 
(A) of grievances and adverse actions aris-
ing under collective bargaining agreements, and 
(B) of disputes or impasses arising in the 
negotiation of such agreements. 
(d) CONFORMING AMENDMENT.—Section 3(e) of the 
Labor-Management Reporting and Disclosure Act of 1959 
(42 U.S.C. 402(e)) is amended by inserting ‘‘the United 
States Health Service and’’ after ‘‘and includes’’. 
SEC. 324. DEFENSE OF CERTAIN MALPRACTICE AND NEG-
LIGENCE SUITS. 
(a) EXCLUSIVE REMEDY.—The remedy against the 
United States provided by sections 1346(b) and 2672 of 
title 28, United States Code, or by alternative benefits 
provided by the United States where the availability of 
such benefits precludes a remedy under section 1346(b) 
of such title, for damage for personal injury, including 
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