Posted on 02/14/2009 12:15:30 PM PST by TornadoAlley3
H.R.676 Title: To provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes. Sponsor: Rep Conyers, John, Jr. [MI-14] (introduced 1/26/2009) Cosponsors (42)
Latest Major Action: 1/26/2009 Referred to House committee. Status: 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 determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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SUMMARY AS OF: 1/26/2009--Introduced.
United States National Health Care Act or the Expanded and Improved Medicare for All Act - Establishes the United States National Health Care (USNHC) Program to provide all U.S. residents with free health care that includes all medically necessary care, such as primary care and prevention, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.
Prohibits an institution from participating unless it is a public or nonprofit institution. Allows nonprofit health maintenance organizations (HMOs) that deliver care in their own facilities to participate.
Gives patients the freedom to choose from participating physicians and institutions.
Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act. Allows such insurers to sell benefits that are not medically necessary, such as cosmetic surgery benefits.
Sets forth methods to pay institutional providers of care and health professionals for services. Prohibits financial incentives between HMOs and physicians based on utilization.
Establishes the USNHC Trust Fund to finance the Program with amounts deposited: (1) from existing sources of government revenues for health care; (2) by increasing personal income taxes on the top 5% income earners; (3) by instituting a progressive excise tax on payroll and self-employment income; and (4) by instituting a small tax on stock and bond transactions. Transfers and appropriates to carry out this Act amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the State Children's Health Insurance Program.
Requires the USNHC Program to give first priority in retraining and job placement and USNHC employment transition benefits to individuals whose jobs are eliminated due to reduced administration.
Requires creation of a confidential electronic patient record system.
Establishes a National Board of Universal Quality and Access to provide advice on quality, access, and affordability.
Provides for: (1) the eventual integration of the Indian Health Service into the Program; and (2) evaluation of the continued independence of Department of Veterans Affairs health programs.
You know everytime you get a treatment there's a voodoo doll somewhere havin' a bad day.
Naturally. It also dictates a mandatory bill and maintains the gov't monopoly in the market.
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 USNHC Program 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 number shall not be used for purposes of registration under this section.
(b) Registration- Individuals and families shall receive a United States National Health Insurance Card in the mail, after filling out a United States National Health Insurance application form at a health care provider. Such application form shall be no more than 2 pages long.
(c) Presumption- Individuals who present themselves 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 United States National Health Insurance Card and have payment made for such benefits.
(d) Residency Criteria- The Secretary shall promulgate a rule that provides criteria for determining residency for eligibility purposes under the USNHC Program.
(e) Coverage for Visitors- The Secretary shall promulgate a rule regarding visitors from other countries who seek premeditated non-emergency surgical procedures. Such a rule should facilitate the establishment of country-to-country reimbursement arrangements or self 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) Inpatient care.
(3) Outpatient care.
(4) Emergency care.
(5) Prescription drugs.
(6) Durable medical equipment.
(7) Long-term care.
(8) Palliative care.
(9) Mental health services.
(10) The full scope of dental services (other than cosmetic dentistry).
(11) Substance abuse treatment services.
(12) Chiropractic services.
(13) Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
(14) Hearing services, including coverage of hearing aids.
(15) 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 benefits.
(c) No Cost-Sharing- No deductibles, copayments, 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-Profit-
(1) IN GENERAL- No institution may be a participating 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 PROVIDERS- For-profit providers of care opting to participate shall be required to convert to not-for-profit status.
(3) PRIVATE DELIVERY OF CARE REQUIREMENT- For-profit providers of care that convert to non-profit status shall remain privately owned and operated entities.
(4) COMPENSATION FOR CONVERSION- The owners of such for-profit providers shall be compensated 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 appropriated from the Treasury such sums as are necessary 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 feasible conversion of for-profit providers of care.
(b) Quality Standards-
(1) IN GENERAL- Health care delivery facilities must meet State quality and licensing guidelines as a condition of participation under such program, 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 Organizations-
(1) IN GENERAL- Non-profit health maintenance 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 section 202.
(2) EXCLUSION OF CERTAIN HEALTH MAINTENANCE ORGANIZATIONS- Other health maintenance organizations, including those which principally contract to pay for services delivered by non-employees, shall be classified 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 coverage).
(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 coverage 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;
(C) reimbursement levels for providers consistent with subtitle B; and
(D) a health professional education budget, including amounts for the continued funding of resident physician training programs.
(2) REGIONAL ALLOCATION- After Congress appropriates amounts for the annual budget for the USNHC Program, the Director shall provide the regional offices with an annual funding allotment to cover the costs of each region’s expenditures. Such allotment shall cover global budgets, reimbursements to clinicians, health professional education, and capital expenditures. Regional offices may receive additional funds from the national program at the discretion of the Director.
(b) Operating Budget- The operating budget shall be used for—
(1) payment for services rendered by physicians and other clinicians;
(2) global budgets for institutional providers;
(3) capitation payments for capitated groups; and
(4) administration of the Program.
(c) Capital Expenditures Budget- The capital expenditures budget shall be used for funds needed for—
(1) the construction or renovation of health facilities; and
(2) for major equipment purchases.
(d) Prohibition Against Co-Mingling Operations and Capital Improvement Funds- It is prohibited to use funds under this Act that are earmarked—
(1) for operations for capital expenditures; or
(2) for capital expenditures for operations.
SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLINICIANS.
(a) Establishing Global Budgets; Monthly Lump Sum-
(1) IN GENERAL- The USNHC Program, through its regional offices, shall pay each institutional provider of care, including hospitals, nursing homes, community or migrant health centers, home care agencies, or other institutional providers or pre-paid group practices, a monthly lump sum to cover all operating expenses under a global budget.
(2) ESTABLISHMENT OF GLOBAL BUDGETS- The global budget of a provider shall be set through negotiations between providers, State directors, and regional directors, but are subject to the approval of the Director. The budget shall be negotiated annually, based on past expenditures, projected changes in levels of services, wages and input, costs, a provider’s maximum capacity to provide care, and proposed new and innovative programs.
(b) Three Payment Options for Physicians and Certain Other Health Professionals-
(1) IN GENERAL- The Program shall pay physicians, dentists, doctors of osteopathy, pharmacists, psychologists, chiropractors, doctors of optometry, nurse practitioners, nurse midwives, physicians’ assistants, and other advanced practice clinicians as licensed and regulated by the States by the following payment methods:
(A) Fee for service payment under paragraph (2).
(B) Salaried positions in institutions receiving global budgets under paragraph (3).
(C) Salaried positions within group practices or non-profit health maintenance organizations receiving capitation payments under paragraph (4).
(2) FEE FOR SERVICE-
(A) IN GENERAL- The Program shall negotiate a simplified fee schedule that is fair and optimal with representatives of physicians and other clinicians, after close consultation with the National Board of Universal Quality and Access and regional and State directors. Initially, the current prevailing fees or reimbursement would be the basis for the fee negotiation for all professional services covered under this Act.
(B) CONSIDERATIONS- In establishing such schedule, the Director shall take into consideration the following:
(i) The need for a uniform national standard.
(ii) The goal of ensuring that physicians, clinicians, pharmacists, and other medical professionals be compensated at a rate which reflects their expertise and the value of their services, regardless of geographic region and past fee schedules.
(C) STATE PHYSICIAN PRACTICE REVIEW BOARDS- The State director for each State, in consultation with representatives of the physician community of that State, shall establish and appoint a physician practice review board to assure quality, cost effectiveness, and fair reimbursements for physician delivered services.
(D) FINAL GUIDELINES- The Director shall be responsible for promulgating final guidelines to all providers.
(E) BILLING- Under this Act physicians shall submit bills to the regional director on a simple form, or via computer. Interest shall be paid to providers who are not reimbursed within 30 days of submission.
(F) NO BALANCE BILLING- Licensed health care clinicians who accept any payment from the USNHC Program may not bill any patient for any covered service.
(G) UNIFORM COMPUTER ELECTRONIC BILLING SYSTEM- The Director shall create a uniform computerized electronic billing system, including those areas of the United States where electronic billing is not yet established.
(3) SALARIES WITHIN INSTITUTIONS RECEIVING GLOBAL BUDGETS-
(A) IN GENERAL- In the case of an institution, such as a hospital, health center, group practice, community and migrant health center, or a home care agency that elects to be paid a monthly global budget for the delivery of health care as well as for education and prevention programs, physicians and other clinicians employed by such institutions shall be reimbursed through a salary included as part of such a budget.
(B) SALARY RANGES- Salary ranges for health care providers shall be determined in the same way as fee schedules under paragraph (2).
(4) SALARIES WITHIN CAPITATED GROUPS-
(A) IN GENERAL- Health maintenance organizations, group practices, and other institutions may elect to be paid capitation payments to cover all outpatient, physician, and medical home care provided to individuals enrolled to receive benefits through the organization or entity.
(B) SCOPE- Such capitation may include the costs of services of licensed physicians and other licensed, independent practitioners provided to inpatients. Other costs of inpatient and institutional care shall be excluded from capitation payments, and shall be covered under institutions’ global budgets.
(C) PROHIBITION OF SELECTIVE ENROLLMENT- Patients shall be permitted to enroll or disenroll from such organizations or entities without discrimination and with appropriate notice.
(D) HEALTH MAINTENANCE ORGANIZATIONS- Under this Act—
(i) health maintenance organizations shall be required to reimburse physicians based on a salary; and
(ii) financial incentives between such organizations and physicians based on utilization are prohibited.
SEC. 203. PAYMENT FOR LONG-TERM CARE.
(a) Allotment for Regions- The Program shall provide for each region a single budgetary allotment to cover a full array of long-term care services under this Act.
(b) Regional Budgets- Each region shall provide a global budget to local long-term care providers for the full range of needed services, including in-home, nursing home, and community based care.
(c) Basis for Budgets- Budgets for long-term care services under this section shall be based on past expenditures, financial and clinical performance, utilization, and projected changes in service, wages, and other related factors.
(d) Favoring Non-Institutional Care- All efforts shall be made under this Act to provide long-term care in a home- or community-based setting, as opposed to institutional care.
SEC. 204. MENTAL HEALTH SERVICES.
(a) In General- The Program shall provide coverage for all medically necessary mental health care on the same basis as the coverage for other conditions. Licensed mental health clinicians shall be paid in the same manner as specified for other health professionals, as provided for in section 202(b).
(b) Favoring Community-Based Care- The USNHC Program shall cover supportive residences, occupational therapy, and ongoing mental health and counseling services outside the hospital for patients with serious mental illness. In all cases the highest quality and most effective care shall be delivered, and, for some individuals, this may mean institutional care.
SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, MEDICAL SUPPLIES, AND MEDICALLY NECESSARY ASSISTIVE EQUIPMENT.
(a) Negotiated Prices- The prices to be paid each year under this Act for covered pharmaceuticals, medical supplies, and medically necessary assistive equipment shall be negotiated annually by the Program.
(b) Prescription Drug Formulary-
(1) IN GENERAL- The Program shall establish a prescription drug formulary system, which shall encourage best-practices in prescribing and discourage the use of ineffective, dangerous, or excessively costly medications when better alternatives are available.
(2) PROMOTION OF USE OF GENERICS- The formulary shall promote the use of generic medications but allow the use of brand-name and off-formulary medications.
(3) FORMULARY UPDATES AND PETITION RIGHTS- The formulary shall be updated frequently and clinicians and patients may petition their region or the Director to add new pharmaceuticals or to remove ineffective or dangerous medications from the formulary.
SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSEMENT LEVELS.
Reimbursement levels under this subtitle shall be set after close consultation with regional and State Directors and after the annual meeting of National Board of Universal Quality and Access.
Subtitle B—Funding
SEC. 211. OVERVIEW: FUNDING THE USNHC PROGRAM.
(a) In General- The USNHC Program is to be funded as provided in subsection (c)(1).
(b) USNHC Trust Fund- There shall be established a USNHC Trust Fund in which funds provided under this section are deposited and from which expenditures under this Act are made.
(c) Funding-
(1) IN GENERAL- There are appropriated to the USNHC Trust Fund amounts sufficient to carry out this Act from the following sources:
(A) Existing sources of Federal Government revenues for health care.
(B) Increasing personal income taxes on the top 5 percent income earners.
(C) Instituting a modest and progressive excise tax on payroll and self-employment income.
(D) Instituting a small tax on stock and bond transactions.
(2) SYSTEM SAVINGS AS A SOURCE OF FINANCING- Funding otherwise required for the Program is reduced as a result of—
(A) vastly reducing paperwork;
(B) requiring a rational bulk procurement of medications under section 205(a); and
(C) improved access to preventive health care.
(3) ADDITIONAL ANNUAL APPROPRIATIONS TO USNHC PROGRAM- Additional sums are authorized to be appropriated annually as needed to maintain maximum quality, efficiency, and access under the Program.
SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS.
Notwithstanding any other provision of law, there are hereby transferred and appropriated to carry out this Act, amounts from the Treasury equivalent to the amounts the Secretary estimates would have been appropriated and expended for Federal public health care programs, including funds that would have been appropriated under the Medicare program under title XVIII of the Social Security Act, under the Medicaid program under title XIX of such Act, and under the Children’s Health Insurance Program under title XXI of such Act.
Reagan on how the Left will attempt to do this: http://dirtyworldnews.com/audio/ronald-reagan-socialized-medicine.mp3
shaking my head in disgust . . .
YA right..wonder just who do they think pays all the medicare claims now. it sure is not the goverment..
Wow! It’s FREE!!!!
This provision destroys all existing private health insurance. It is a total nationalization of health care insurance and by extension health care providers. I expect to see the hammer and sickle flying shortly. Free government provided cremation services following the government inflicted acute lead poisoning.
if passed, this cannot be undone
By my standards, the country is already broke and these idiots want to finish the job.
bttt
Yep...it clearly states:
"All individuals residing in the United States "
Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act. Allows such insurers to sell benefits that are not medically necessary, such as cosmetic surgery benefits.
I asked my health insurance agent today how the bill will affect my Blue Cross coverage-he asked them they don’t seem to know-
Are we just suppose to sit around and wait for the insurance companies to “get it” and by then it will really be too late to do anything to stop it why isn’t this on Fox News?
“Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act. Allows such insurers to sell benefits that are not medically necessary, such as cosmetic surgery benefits.”
I asked my health insurance agent today how the bill will affect my Blue Cross coverage-he asked them they don’t seem to know-
Are we just suppose to sit around and wait for the insurance companies to “get it” and by then it will really be too late to do anything to stop it why isn’t this on Fox News?
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