H.R. 676 (Conyers)

Name of new program
United States National Health Care Program. 

Target population(s)
All individuals. 

Eligibility
All individuals residing in the US (including any territory of the US).  

Type of coverage
Comprehensive coverage of all medically necessary services, including primary care and prevention, inpatient and outpatient care, long term care, palliative care, emergency care, mental health services, prescription drugs, durable medical equipment, the full scope of dental services (other than cosmetic dentistry), substance abuse treatment services, chiropractic services and basic vision care and vision correction (other than laser vision correction), hearing services and podiatric care. No cost-sharing would be imposed. Benefits would only be available from public or non-profit institutions. Private physicians, private clinics, and private health care providers could continue to operate as private entities but could not be investor-owned. Government would compensate investors in for-profit enterprises for reasonable losses from converting to private, non-profit status over a 15 year period (except losses from business profits). Non-profit HMOs that deliver care in their own facilities and employ clinicians on a salaried basis could participate in the program. 

Premiums
There would be no premiums. 

Government subsidies
Benefits would be fully subsidized, with no cost sharing. Congress would establish an annual budget and appropriate funds. Each geographic region would receive an allotment. Institutional providers, including hospitals and nursing homes, community or migrant health centers and other specified providers, would receive monthly lump-sum payments under a global budget. Professionals would receive fee-for-service payments under a negotiated fee schedule that is based initially on current prevailing fees or reimbursement. 

Financing
The program would be financed by reducing paperwork; by requiring a rational bulk procurement of medications; by improving access to preventive health care; from existing sources of Federal government revenues for health care, including those for Medicare, Medicaid and the Children’s Health Insurance Program; by increasing personal income taxes on the top 5 percent of income earners; by instituting a payroll tax; and by instituting a tax on stock and bond transactions. 

Effective date
One year after the date of enactment. 

Administration
Would be administered by the Secretary through a Director appointed by the Secretary.  The Director would appoint a Director for long term care and one for mental health. A National Board of Universal Quality and Access would be appointed and would report its recommendations twice each year to the Secretary, Director, Congress and the President. 

Other provisions in bill
After a period of 10 years, the Congress would be required to determine whether the Department of Veterans’ Affairs should continue to operate independent of the new National Health Care Program.  The Indian Health Service programs would remain independent for the first 5 years of the National Health Care Program.