I 
108TH CONGRESS 
1ST SESSION H. R. 3000
To establish a United States Health Service to provide high quality com-
prehensive health care for all Americans and to overcome the deficiencies 
in the present system of health care delivery. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 4, 2003
Ms. LEE (for herself, Mrs. CHRISTENSEN, Mr. KUCINICH, Mr. CUMMINGS, 
Mr. DAVIS of Illinois, Mr. OWENS, Mr. JACKSON of Illinois, Ms. WOOL-
SEY, Mr. PAYNE, Mr. CONYERS, and Ms. CARSON of Indiana) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committees on Education and the 
Workforce and Ways and Means, 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 establish a United States Health Service to provide high 
quality comprehensive health care for all Americans and 
to overcome the deficiencies in the present system of 
health care delivery.
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 
‘‘Josephine Butler United States Health Service Act’’.
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows:
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
Sec. 3. Purposes. 
Sec. 4. Definitions. 
TITLE I—ESTABLISHMENT AND OPERATION OF THE UNITED 
STATES HEALTH SERVICE 
Sec. 101. Establishment of the Service. 
Sec. 102. Appointment of the National Health Board. 
Sec. 103. Powers and duties of the National Health Board. 
Sec. 104. Representation in local and regional authorities. 
Sec. 105. Public accountability and financial disclosure. 
Sec. 106. Inspector General. 
Sec. 107. Establishment of health care delivery regions. 
TITLE II—DELIVERY OF HEALTH CARE AND SUPPLEMENTAL 
SERVICES 
Subtitle A—Patients’ Rights in Health Care Delivery 
Sec. 201. Basic health rights. 
Sec. 202. Right to paid leave to receive health care services. 
Subtitle B—Eligibility for, Nature of, and Scope of Services Provided by the 
Service 
Sec. 211. Eligibility for services. 
Sec. 212. Entitlement to services. 
Sec. 213. Provision of health care and supplemental services. 
Subtitle C—Health Care Facilities and Delivery of Health Care Services 
Sec. 221. Establishment of health care facilities and distribution of delivery of 
health care and other services. 
Sec. 222. Operation and inspection of health care facilities. 
Sec. 223. Provision of health services relating to reproduction and childbearing. 
TITLE III—HEALTH LABOR FORCE 
Subtitle A—Job Categories and Certification 
Sec. 301. Effect of State law. 
Sec. 302. Qualifications of health workers. 
Sec. 303. Establishment of job categories and certification standards. 
Subtitle B—Education of Health Workers 
Sec. 311. Health team schools. 
Sec. 312. Service requirement. 
Sec. 313. Payment for certain educational loans. 
Subtitle C—Employment and Labor-Management Relations Within the Service
Sec. 321. Employment, transfer, promotion, and receipt of fees. 
Sec. 322. Applicability of laws relating to Federal employees. 
Sec. 323. Applicability of Federal labor-management relations laws. 
Sec. 324. Defense of certain malpractice and negligence suits. 
TITLE IV—OTHER FUNCTIONS OF HEALTH BOARDS 
Subtitle A—Advocacy, Grievance Procedures, and Trusteeships 
Sec. 401. Advocacy and legal services program. 
Sec. 402. Grievance procedures. 
Subtitle B—Occupational Safety and Health Programs 
Sec. 411. Functions of the National Health Board. 
Sec. 412. Community occupational safety and health activities. 
Sec. 413. Workplace health facilities. 
Sec. 414. Employee rights relating to occupational safety and health. 
Sec. 415. Definitions. 
Subtitle C—Health and Health Care Delivery Research, Quality Assurance, 
and Health Equity 
Sec. 421. Principles and guidelines for research. 
Sec. 422. Establishment of institutes. 
Subtitle D—Health Planning, Distribution of Drugs and Other Medical 
Supplies, and Miscellaneous Functions 
Sec. 431. Health planning and budgeting. 
Sec. 432. Distribution of drugs and other medical supplies. 
Sec. 433. Miscellaneous functions of the National Health Board. 
TITLE V—FINANCING OF THE SERVICE 
Subtitle A—Health Service Taxes 
Sec. 501. Individual and corporate income taxes. 
Sec. 502. Other changes in the Internal Revenue Code of 1986. 
Sec. 503. Existing employer-employee health benefit plans. 
Sec. 504. Workers compensation programs. 
Subtitle B—Health Service Trust Fund 
Sec. 511. Establishment of health service trust fund. 
Sec. 512. Transfer of funds to the health service trust fund. 
Sec. 513. Administration of health service trust fund. 
Subtitle C—Preparation of Plans and Budgets 
Sec. 521. Determination of fund availability. 
Sec. 522. Preparation of regional budgets. 
Subtitle D—Allocation and Distribution of Funds 
Sec. 531. National budget. 
Sec. 532. Special operating expense fund. 
Sec. 533. Distribution of funds. 
Sec. 534. Annual statement, records, and audits.
Subtitle E—General Provisions 
Sec. 541. Issuance of obligations. 
Sec. 542. Definitions. 
TITLE VI—MISCELLANEOUS PROVISIONS 
Sec. 601. Effective date of health services. 
Sec. 602. Repeal of provisions. 
Sec. 603. Transition provisions. 
Sec. 604. Amendment to Budget and Accounting Act. 
Sec. 605. Separability.
SEC. 2. FINDINGS. 
The Congress makes the following findings: 
(1) The health of the Nation’s people is a foun-
dation of their well-being. 
(2) High quality health care is a right of all 
people.
(3) Many of the Nation’s people are unable 
fully to exercise this right because of the inability of 
the present health care delivery system to make high 
quality health care available to all individuals re-
gardless of race, sex, age, national origin, income, 
marital status, sexual orientation, religion, political 
belief, place of residence, employment status, or pre-
vious health status. 
(4) The present health care system has failed to 
provide financial coverage for health care services 
for more than forty million Americans, and the per-
cent lacking such coverage grows each year. 
(5) The present health care system has failed to 
provide for sufficient effective preventive measures
that would address the deterioration in occupational, 
environmental, and social conditions affecting the 
health of the people of this Nation. 
(6) Unnecessary and excessive profits and ad-
ministrative expenses have inflated the cost of health 
care. 
(7) The growth of for profit medical care and 
for profit managed care is making it difficult for 
health care personnel to provide, and users to re-
ceive, the full range of health services they believe to 
be necessary, appropriate, and desirable. 
(8) The health professions have failed to control 
the cost of their services and the imbalance in the 
number of health workers among geographic areas 
or health care specialties. 
(9) The present health care system has failed to 
make full and efficient use of allied health workers. 
(10) A United States Health Service is the best 
means to implement the right to high quality health 
care and to overcome the deficiencies in the present 
health care delivery system. 
SEC. 3. PURPOSES. 
The purposes of this Act are as follows: 
(1) To create a United States Health Service to 
provide without charge to all residents, regardless of
race, sex, age, national origin, income, marital sta-
tus, sexual orientation, religion, political belief, place 
of residence, employment status, or previous health 
status, comprehensive health care services delivered 
by salaried health workers and emphasizing the pro-
motion and maintenance of health as well as the 
treatment of illness. 
(2) To establish representative and democratic 
governance of the Service. 
(3) To provide health workers in the Service 
with fair and reasonable compensation, secure em-
ployment, opportunities for full and equal participa-
tion in the governance of health facilities, and oppor-
tunities for advancement without regard to race, sex, 
age, national origin, sexual orientation, religion, or 
political belief. 
(4) To increase the availability and continuity 
of health care by linking local health care facilities 
to hospitals and specialized care facilities. 
(5) To overcome present disparities in health 
and access to health care resources, especially for 
currently underserved innercity and rural popu-
lations, minority groups, prisoners, and occupational 
groups, by redistributing health care resources to
underserved populations, and by enhancing public 
health and preventive health services. 
(6) To finance the Service through progressive 
taxation of individuals and employer contributions, 
and to distribute these revenues on a capitation 
basis, supplemented by allocations to meet special 
health care needs. 
SEC. 4. DEFINITIONS. 
For the purposes of this Act, unless the context im-
plies otherwise: 
(1) 
HEALTH
CARE
FACILITY.—The 
term 
‘‘health care facility’’ means an administrative unit 
composed of specified staff, equipment, and premises 
and established by a health board as an appropriate 
unit of organization for the delivery of specified 
health care or supplemental services under this Act. 
(2) HEALTH
WORKER.—The term ‘‘health 
worker’’ includes—
(A) any employee of the Service; and 
(B) any individual who for remuneration 
delivers, administers any program in, provides 
supporting services for, teaches the subject 
matter of, or performs research in, health care 
services.
(3) INDIRECT PROVIDER OF HEALTH CARE.—
The term ‘‘indirect provider of health care’’ means 
an individual who—
(A) receives (either directly or through his 
or her spouse) more than 1⁄10 of his or her 
gross annual income from any one or combina-
tion of—
(i) fees or other compensation for pro-
vision of, research into, or instruction in, 
the provision of health care, 
(ii) entities engaged in the provision 
of health care or in such research or in-
struction, 
(iii) producing or supplying drugs, 
medical equipment, or other articles for in-
dividuals or entities for use in the provi-
sion of or in research into or instruction in 
the provision of health care, or 
(iv) entities engaged in producing 
drugs, medical equipment, or such other 
articles; 
(B) holds a fiduciary position with, or has 
a fiduciary interest in, any entity described in 
clause (ii) or (iv) of subparagraph (A); or
(C) is engaged in issuing any policy or con-
tract of individual or group health insurance or 
hospital or medical service benefits. 
(4) NATIONAL
HEALTH
BOARD.—The term 
‘‘National Health Board’’ means the National 
Health Board of the Service. 
(5) SERVICE.—The term ‘‘Service’’ means the 
United States Health Service established in section 
101. 
(6) SERVICE-RELATED TERMS.—
(A) HEALTH CARE SERVICES.—The term 
‘‘health care services’’ means the services de-
scribed in paragraphs (1) through (5) of section 
213(a). 
(B) SUPPLEMENTAL SERVICES.—The term 
‘‘supplemental services’’ means the services de-
scribed in paragraphs (1), (2), and (3) of sec-
tion 213(b). 
(7) USER.—The term ‘‘user’’ means an indi-
vidual who is eligible under section 211 to receive 
health care services from the Service under this Act.
TITLE I—ESTABLISHMENT AND 
OPERATION OF THE UNITED 
STATES HEALTH SERVICE 
SEC. 101. ESTABLISHMENT OF THE SERVICE. 
(a) IN GENERAL.—There is established, as an inde-
pendent establishment of the executive branch of the 
United States, the United States Health Service. 
(b) AUTHORITY.—
(1) NATIONAL HEALTH BOARD.—The authority 
of the Service shall be exercised by the National 
Health Board and, in accordance with this Act and 
guidelines established by such Board, by local and 
regional authorities affiliated with the Board. 
(2) EMINENT DOMAIN AUTHORITY.—The Serv-
ice shall have the authority, under the power of emi-
nent domain, to acquire by condemnation under ju-
dicial process real estate for the Service for public 
purposes whenever it is necessary or advantageous 
to do so. 
(c) ADMINISTRATION.—The Board shall implement 
administrative measures as necessary to assure the equi-
table distribution and allocation of health care resources 
and services. 
(d) ACCOUNTABILITY AND CONTROL.—The Board 
shall establish mechanisms to assure accountable, rep-
resentative and democratic governance of the Service and 
of health care facilities by health care users and workers, 
with limits on conflicts of interest as described in this Act. 
SEC. 102. APPOINTMENT OF THE NATIONAL HEALTH 
BOARD. 
The President shall, no later than 30 days after the 
date of the enactment of this Act, appoint 21 individ-
uals—
(1) who are 18 years of age or older; 
(2) who are concerned about the health care 
problems of the Nation; 
(3) who approximate the Nation’s population by 
race, sex, income, language, and region of residence, 
and approximate the percentage of rural and fron-
tier populations; and 
(4) no more than seven of whom are or have 
been health workers, indirect providers of health 
care, or members of the immediate family of such 
workers or indirect providers within 24 months of 
the date of such nomination, to serve as members of 
the National Health Board of the Service. 
SEC. 103. POWERS AND DUTIES OF THE NATIONAL HEALTH 
BOARD. 
The National Health Board shall—
(1) establish the boundaries of health care de-
livery regions, in accordance with section 107; 
(2) establish procedures for creating local and 
regional authorities within each health care delivery 
region, to oversee and administer the delivery of 
health services, pursuant to section 104, and other 
provisions of this Act in their respective regions and 
local areas; 
(3) carry out such duties of the National 
Health Board as it deems necessary and consistent 
with the timetable given under this Act and the pur-
poses of the Service; and 
(4) provide for the recording of minutes of each 
of its meetings, and shall make such records avail-
able to the public for inspection and copying. 
SEC. 104. REPRESENTATION IN LOCAL AND REGIONAL AU-
THORITIES. 
The governing bodies of the local and regional au-
thorities created pursuant to section 103(b) shall consist 
of representatives of users resident in their local area or 
region and representatives of health workers employed by 
the Service in their local area or region. Representatives 
of such users shall comprise the majority of such rep-
resentatives and representatives of such health workers 
shall comprise a minority.
SEC. 105. PUBLIC ACCOUNTABILITY AND FINANCIAL DIS-
CLOSURE. 
(a) PROHIBITION OF CONFLICTS OF INTEREST.—
(1) IN GENERAL.—Individuals with direct or in-
direct conflicts of interest shall not serve on health 
boards or authorities. Subject to paragraph (2), such 
conflicts may consist of ownership of, employment 
in, or other financial affiliation with any industry in 
a position to profit or otherwise benefit from the ac-
tivities of the health board. 
(2) EXCEPTION.—Paragraph (1) shall not 
apply to employment as a health worker by the Serv-
ice as specified in this Act. 
(b) DISCLOSURE.—Candidates for health boards or 
authorities shall fully disclose any such potential conflicts 
of interest, and if elected or appointed shall sever any af-
filiations that could result in a conflict. 
SEC. 106. INSPECTOR GENERAL FOR HEALTH SERVICES. 
Within the United States Health Service there shall 
be an Office of the Inspector General for Health Services, 
to be headed by an Inspector General for Health Services, 
that shall have authority to ensure the effective operation 
of the services pursuant to this Act and to investigate and 
pursue any grievances against the National Health Board 
or its local authorities. The Inspector General shall have
the same authority as an Inspector General has under the 
Inspector General Act of 1978. 
SEC. 107. ESTABLISHMENT OF HEALTH CARE DELIVERY RE-
GIONS. 
(a) ESTABLISHMENT OF HEALTH CARE DELIVERY 
REGIONS.—No later than 6 months after the appointment 
of members of the National Health Board, such Board 
shall establish, in accordance with this section, health care 
delivery regions throughout the United States.
(b) REQUIREMENTS FOR DELIVERY REGIONS.—Each 
health care delivery region shall meet the following re-
quirements: 
(1) The region shall be a contiguous geographic 
area appropriate for the effective governance, plan-
ning, and delivery of all health care and supple-
mental services under this Act for residents of the 
region. 
(2) The region shall have a population of not 
less than 500,000 and of not more than 3,000,000 
individuals, except that—
(A) the population of a region may be 
more than 3,000,000 if the region includes a 
standard metropolitan statistical area (as deter-
mined by the Office of Management and Budg-
et) with a population of more than 3,000,000; 
and 
(B) the population of a region may be less 
than 500,000 if the National Health Board de-
termines that this is necessary to facilitate the 
delivery of health care and supplemental serv-
ices or the effective governance of the health 
program within such region. 
A region under subparagraph (B) may be a sparsely 
populated frontier area which consists of a very 
large or multi-state geographic area. 
(3) The boundaries of each region shall take 
into account—
(A) any economic or geographic barrier to 
the receipt of health care and supplemental 
services in nonmetropolitan areas, and 
(B) the differences in needs between non-
metropolitan and metropolitan areas in the 
planning, development, and delivery of health 
care and supplemental services. 
(c) MODIFICATION OF BOUNDARIES.—The National 
Health Board shall review the boundaries of regions no 
later than 2 years after each decennial national census, 
or upon receipt of and at such other times as it deems 
necessary, and may modify the boundary of any region
in which there has been a substantial shift of population 
justifying such modification or if such modification would 
better carry out the purposes of this Act, and if such modi-
fication is approved in a referendum of residents in an 
area whose regional identification would be changed by 
making such modification. 
(d) PROCESS.—At least 60 days prior to the estab-
lishment of the boundaries of any region, or modification 
of the boundaries, the National Health Board shall col-
laborate with its regional authorities to provide for—
(1) notice in the area which would be affected 
by the establishment of such boundaries of the 
boundaries proposed to be established, and of the 
date, time, and location of the public hearing on 
such establishment as provided in paragraph (2); 
and 
(2) a public hearing at which individuals can 
speak or present written statements relating to the 
establishment of such boundaries.
TITLE II—DELIVERY OF HEALTH 
CARE 
AND 
SUPPLEMENTAL 
SERVICES 
Subtitle A—Patients’ Rights in 
Health Care Delivery 
SEC. 201. BASIC HEALTH RIGHTS. 
The Service, in its delivery of health care services to 
users, shall ensure that every such individual is given the 
following basic health rights: 
(1) The right to receive high quality health care 
and supplemental services from any facility within 
the Service capable of providing such services with-
out charge and without discrimination on account of 
race, sex, age, religion, language, income, marital 
status, sexual orientation, dress, or previous health 
status. 
(2) The right to humane, respectful, dignified, 
and comforting health care, and to the reduction of 
pain and distressful symptoms. 
(3) The right to have all medically necessary or 
appropriate health services delivered in a convenient 
and timely manner. Any decision to deny or post-
pone such necessary or appropriate care shall be 
made only on the basis of temporary and reasonable 
limitations in the availability of service personnel
and physical facilities. Users shall have the oppor-
tunity for timely and effective appeal of any decision 
to deny or postpone care. 
(4) The right to choose the health workers who 
shall be responsible for, and the health facilities in 
which to receive, the individual’s health care serv-
ices. 
(5) The right of access to all information, in-
cluding the individual’s health records and the med-
ical dictionary produced under section 433(b), which 
promotes an understanding of health. 
(6) The right to have all health care informa-
tion, reports, and educational materials translated 
into the individual’s primary language. 
(7) The right to receive, prior to the delivery of 
any health care service, a careful, prompt, and intel-
ligible—
(A) explanation of the indications, diag-
noses, benefits, side effects, and risks involved 
in the delivery of such service, and a description 
of all medically necessary or appropriate alter-
natives to such service (including no treatment); 
(B) answer to any question relating to 
such health care service; and
(C) explanation of one’s health rights de-
scribed in this subtitle, and the right to have 
such health care service delivered only with the 
individual’s prior, voluntary, written consent. 
(8) The right to refuse the initial or continuing 
delivery of any health care service whenever such re-
fusal does not directly endanger the public health or, 
in accordance with State law, the health of the indi-
vidual if the individual is dangerous to himself or 
herself.
(9) The right to have all individually identifi-
able information and documents treated confiden-
tially and not disclosed (except for statistical pur-
poses and for the control of communicable diseases, 
drug abuse, and child abuse) without the individual’s 
prior, voluntary, and written consent. 
(10) The right of access at all times to individ-
uals or groups for counseling, health information, 
and assistance on health matters, including access to 
user advocates who shall—
(A) assist users in choosing the most ap-
propriate sites from which to receive health 
services and the most appropriate health work-
ers from whom to receive such services;
(B) provide counseling and assistance to 
users in filing complaints; and 
(C) investigate instances of poor quality 
services or improper treatment of users and 
bring such instances to the attention of the ap-
plicable authority. 
(11) The right to be accompanied and visited at 
any time by a friend, relative, or independent advo-
cate of the individual’s choosing, and the right to 
have routine services, such as feeding, bathing, 
dressing, and bedding changes, performed by a 
friend or relative, if the individual so chooses. 
(12) The right, in the event of terminal illness, 
to die with a maximum degree of dignity, to be pro-
vided all necessary symptom relief, to be provided 
(and for the individual’s family to be provided) coun-
seling and comfort, and to be allowed (if desired) to 
die at home. 
(13) The right of access to a complaint and 
grievance system and to legal assistance to enforce 
these rights. 
SEC. 202. RIGHT TO PAID LEAVE TO RECEIVE HEALTH 
CARE SERVICES. 
(a) AMENDMENT
TO
FAIR
LABOR
STANDARDS 
ACT.—The Fair Labor Standards Act of 1938 is amended
by inserting after section 7 (29 U.S.C. 207) the following 
new section: 
‘‘MINIMUM HEALTH LEAVE COMPENSATION 
‘‘SEC. 7A. Each employee of any employer who in any 
workweek is engaged in commerce or in the production 
of goods for commerce, or is employed in an enterprise 
engaged in commerce or in the production of goods for 
commerce, shall be entitled to receive from the employer, 
for each 35 hours he is employed by the employer (not 
counting more than 35 hours in any workweek), com-
pensation for one hour of employment at the regular rate 
at which the employee is employed (as that term is used 
in section 7 of this Act) for an hour—
‘‘(1) during the period of 52 weeks beginning 
with the workweek with which the entitlement is 
earned, and 
‘‘(2) during which the employee is unable to 
work because of the need for the employee (or a de-
pendent of that employee) to receive necessary 
health care services.’’. 
(b) CONFORMING AMENDMENTS.—The Fair Labor 
Standards Act of 1938 is further amended—
(1) in section 3(o), by striking ‘‘sections 6 and 
7’’ and inserting ‘‘sections 6, 7, and 7A’’; 
(2) in section 13—
(A) by striking ‘‘and 7’’ in subsection (a) 
before paragraph (1) and inserting ‘‘, 7, and 
7A’’; 
(B) by striking ‘‘sections 6 and 7’’ in sub-
section (a)(3) and inserting ‘‘sections 6, 7, and 
7A’’; and 
(C) by inserting ‘‘7A,’’ in subsections (d) 
and (f) after ‘‘7,’’ each place it appears; 
(3) in section 14(d), by striking ‘‘6 and 7’’ and 
inserting ‘‘6, 7, and 7A’’; 
(4) in section 15(a), by striking ‘‘section 6 or 
section 7’’ and inserting ‘‘section 6, 7, or 7A’’; 
(5) in section 16—
(A) by striking ‘‘section 6 or section 7’’ in 
subsection (b) and inserting ‘‘section 6, 7, or 
7A’’; 
(B) by striking ‘‘or their unpaid overtime 
compensation’’ in subsection (b) and inserting 
‘‘their unpaid overtime compensation, or their 
unpaid health leave compensation’’; 
(C) by inserting ‘‘or of unpaid health leave 
compensation’’ in subsection (b) after ‘‘amount 
of unpaid overtime compensation’’;
(D) by striking ‘‘section 6 or 7’’ in the 
first sentence of subsection (c) and inserting 
‘‘section 6, 7, or 7A’’; 
(E) by striking ‘‘unpaid overtime com-
pensation’’ in the first sentence of subsection 
(c) and inserting ‘‘, unpaid overtime compensa-
tion, or unpaid health leave compensation’’; 
(F) by striking ‘‘or overtime compensa-
tion’’ in the second sentence of subsection (c) 
and inserting ‘‘, overtime compensation, or 
health leave compensation’’; and 
(G) by striking ‘‘or unpaid overtime com-
pensation under sections 6 and 7’’ in the third 
sentence of subsection (c) and inserting ‘‘, un-
paid overtime compensation, or unpaid health 
leave compensation under sections 6, 7, and 
7A’’; and 
(6) in section 18—
(A) by inserting ‘‘or minimum health leave 
compensation higher than the minimum health 
leave compensation established under this Act’’ 
in the first sentence of subsection (a) before ‘‘, 
and no provision’’; and 
(B) by inserting ‘‘, or justify any employer 
in reducing health leave compensation provided
by him which is in excess of the applicable min-
imum health leave compensation under this 
Act’’ before the period at the end of the second 
sentence of subsection (a). 
Subtitle B—Eligibility for, Nature 
of, and Scope of Services Pro-
vided by the Service 
SEC. 211. ELIGIBILITY FOR SERVICES. 
(a) IN GENERAL.—All individuals while within the 
United States are eligible to receive health care and sup-
plemental services under this Act.
(b) UNITED STATES DEFINED.—For purposes of this 
section, the term ‘‘United States’’ includes Indian reserva-
tions, the District of Columbia, the Commonwealth of 
Puerto Rico, the Virgin Islands, Guam, Samoa, and the 
Northern Mariana Islands. 
SEC. 212. ENTITLEMENT TO SERVICES. 
(a) IN GENERAL.—Except as provided in subsection 
(b), the Service shall, on and after the effective date of 
health services, provide users with all health care services 
and supplemental services described in section 213 which 
the Service determines, in accordance with this title, to 
be necessary or appropriate for the promotion and en-
hancement of health, for the prevention of disease, and
for the diagnosis and treatment of, and rehabilitation fol-
lowing, injury, disability, or disease. 
(b) EXCLUSION.—Services provided under this Act 
shall not include personal comfort or cosmetic services un-
less the National Health Board or its designee determines 
that the services are required for health-related reasons. 
SEC. 213. PROVISION OF HEALTH CARE AND SUPPLE-
MENTAL SERVICES. 
(a) IN GENERAL.—The Service shall provide in the 
United States the following health care services in or 
through facilities established by the Service—
(1) the promotion of health and well-being 
through health education programs to be carried out 
in facilities of the Service as well as in workplaces, 
schools, and elsewhere utilizing all appropriate 
media, and by assisting other Government agencies 
in taking appropriate actions to promote health and 
well-being; 
(2) the prevention of illness, injury, and death 
through education and advocacy addressed to the so-
cial, occupational, and environmental causes of ill 
health; through the provision of appropriate preven-
tive services including social, medical, occupational, 
and environmental health services, on both an emer-
gency and sustained basis; through screening and
other early detection programs to identify and ame-
liorate the primary causes of ill health; and, where 
appropriate, through actions taken on an emergency 
basis to halt environmental threats to life and 
health; 
(3) the diagnosis and treatment of illness and 
injury, including emergency medical services, com-
prehensive outpatient and inpatient health care serv-
ices, occupational health services, mental health 
services, dental care, vision care, long-term care, and 
home health services; 
(4) the rehabilitation of the sick and disabled, 
including physical, psychological, occupational, and 
other specialized therapies; and 
(5) the provision of drugs, therapeutic devices, 
appliances, equipment, and other medical supplies 
(including eyeglasses, other visual aids, dental aids, 
hearing aids, and prosthetic devices) certified effec-
tive in the National Pharmacy and Medical Supply 
Formulary (published under section 432(a)) and fur-
nished or prescribed by authorized health workers. 
(b) SUPPLEMENTAL SERVICES.—The Service shall 
provide the following services supplemental to the delivery 
of health care services in or through health care facilities 
established by the Service—
(1) ambulance and other transportation services 
to insure ready and timely access to necessary health 
care; 
(2) child care services for individuals who, dur-
ing the time they receive outpatient health care serv-
ices from the Service or are working in a health care 
facility of the Service, are responsible for a child’s 
care; 
(3) homemaking and home health services—
(A) to enable the provision of inpatient 
health services at a health care facility of the 
Service to an individual who has the sole re-
sponsibility for the care 
(i) of a child under 15 years of age, 
or 
(ii) of a physically or mentally handi-
capped individual who requires the care of 
another individual, and 
(B) for the bedfast or severely handicapped 
individual; and 
(4) such counseling and social service assistance 
as will avoid the unnecessary provision of health care 
services. 
(c) LOCAL PUBLIC HEALTH SERVICES.—The Service 
shall maintain the functions, especially those related to en-
vironmental health and the prevention of illness, currently 
performed by the departments of health of the States and 
localities, to the extent consistent with Federal, State, and 
local law, and shall cooperate with State and local govern-
ments in its conduct of such functions. 
(d) EMERGENCY HEALTH CARE SERVICES.—The 
Service shall provide, at rates established by the National 
Health Board, for reimbursement of the cost of emergency 
health care services furnished in facilities not operated by 
the Service or by health workers not employed by the Serv-
ice, when an injury or acute illness requires immediate 
medical attention under circumstances making it medi-
cally impractical for the ill or injured individual to receive 
care in a Service facility or by an employee of the Service. 
Subtitle C—Health Care Facilities 
and Delivery of Health Care 
Services 
SEC. 221. ESTABLISHMENT OF HEALTH CARE FACILITIES 
AND 
DISTRIBUTION 
OF 
DELIVERY 
OF 
HEALTH CARE AND OTHER SERVICES. 
(a) HEALTH SERVICE AREAS.—The National Health 
Board, in consultation with local authorities and residents 
of the local communities affected, shall establish such 
health care facilities as are necessary to provide all nec-
essary comprehensive primary and specialized health care
services, including distributing such health care resources 
in a manner as to overcome present shortages and ensure 
equitable access for every resident to needed health care 
resources. In establishing such facilities, the National 
Health Board shall rely primarily on existing political 
boundaries for the purposes of allocating health services, 
including cities, counties, perinatal services regions, 
States, and Federal Medicare regions, and shall determine 
the need to establish additional or supplementary regional 
health service areas that may cross existing boundaries.
(b) HEALTH CARE FACILITIES.—
(1) IN GENERAL.—The National Health Board 
and its local authorities shall, not later than the ef-
fective date of health services and to the maximum 
extent feasible, establish and maintain such health 
care facilities as are necessary for the efficient and 
effective delivery to individuals of comprehensive pri-
mary health care services (defined in paragraph (2)), 
specialized health care services (defined in para-
graph (3)), special services (defined in paragraph 
(4)) and community-oriented health measures (de-
fined in paragraph (5)). Such health care facilities 
shall be established and maintained in a manner 
that, as soon as possible and to the greatest extent
(2) EFFECTIVE
DELIVERY.—In its establish-
ment of health care facilities under this section, the 
Board shall seek to minimize fragmentation and du-
plication in delivery of health care and other services 
so as to promote the effective and efficient delivery 
of such services. 
SEC. 223. PROVISION OF HEALTH SERVICES RELATING TO 
REPRODUCTION AND CHILDBEARING. 
(a) PROVISION OF SERVICES.—
(1) IN GENERAL.—The following services shall 
be provided: 
(A) FAMILY PLANNING.—
(i) Complete information on contra-
ception and provision of birth control ma-
terials or medication of the individual’s 
choosing. 
(ii) Complete and effective evaluation 
and treatment of sexually transmitted dis-
eases and diseases of the reproductive or-
gans. 
(iii) Complete information and coun-
seling with respect to pregnancy, child-
bearing, and possible outcomes involving 
genetically induced anomalies. 
(B) PREGNANCY.—