[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4325 Introduced in House (IH)]
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 determined 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 Representatives 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 benefits.
``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
Institute.
Sec. 402. Health Care Quality, Patient Safety, and Workforce Standards
Advisory Committee.
TITLE V--IMPROVING MEDICARE BENEFITS
Sec. 501. Full mental health and substance abuse treatment benefits
parity.
TITLE VI--LONG-TERM AND HOME HEALTH CARE
Sec. 601. Studies and demonstration projects to identify model
programs.
TITLE VII--MISCELLANEOUS
Sec. 701. Nonapplication of ERISA.
Sec. 702. Sense of Congress regarding offsets.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) The health of the American people is the foundation of
American strength, productivity, and wealth.
(2) The guarantee of health care coverage and access to
quality medical care to all Americans is a fundamental right
and is essential to the general welfare.
(3) 43,600,000 Americans, more than 8,500,000 of whom are
children, have no health insurance.
(4) Health insurance coverage is unstable; less than \1/2\
of all adults have been in their current health plan for 3
years.
(5) The average American will hold at least 7 jobs during
their life, risking lack of health coverage every time they
change or are between jobs.
(6) Annual health care expenditures in the United States
total $1.55 trillion.
(7) In the United States, personal health care spending
grows 2.5 percent faster than the gross domestic product.
(8) Although the United States spends considerably 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 because they couldn't afford
it.
(10) Nearly 31,000,000 Americans face collection 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, resulting 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 annually, while other Western
industrialized nations with universal health care systems spend
approximately $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 provide funds to
participating States to enable those States to ensure universal health
insurance coverage by establishing State administered systems targeted
to State residents with a family income that does not exceed 300
percent of the poverty line.
``(b) Expansion Phase (Phase I) Plan Required.--A State is not
eligible for a payment under section 2205(a) unless the State has
submitted to the Secretary 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 coverage 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 subsection (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 residents of the
State, including the steps the State is taking to
identify and enroll all uncovered residents of the
State who are eligible to participate in public or
private health insurance programs.
``(2) Details of, and timelines for, expansion phase (phase
i) plan.--
``(A) Use of funds; coordination.--The activities
that the State intends to carry out using funds
received under this part, including how the State will
coordinate efforts under this part with existing State
efforts to increase the health insurance coverage of
individuals.
``(B) Timelines.--Consistent with subsection (c),
the manner in which the State will reduce the base
coverage gap for the year involved, including a
timetable with specified targets 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 continue to
provide not less than the level of financial support
toward the health insurance premiums required for
coverage of their employees as such employers provided
as of the date of enactment of this title; and
``(B) the State will continue to provide not less
than the level of State expenditures incurred for
State-funded health programs as of such date.
For purposes of this paragraph, any population or service that
was covered under the medicaid program 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
enhanced FMAP formula used under the State children'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 requirements of section 1867 (commonly
referred to as the `Emergency Medical Treatment and Active
Labor Act').
``(6) Representation on boards and commissions.--The manner
in which the State will ensure that all Boards and Commissions
that the State establishes to administer the plan will include,
among others, representatives of providers, consumers,
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 insurers 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 disclosed to the
public.
``(8) Consumer protections.--The manner in which the State
will ensure compliance with sections 2221, 2222, 2223, and
2224.
``(9) Public review.--The manner in which the State will
provide for the public review of institutional changes in
services provided, markets and regions covered, withdrawal or
movement of services, closures or downsizing, and other actions
that affect the provision of health insurance under the plan.
``(10) Services in rural and underserved areas; cultural
competency.--The manner in which the State will ensure--
``(A) coverage in rural and underserved areas; and
``(B) that the needs of culturally diverse
populations are met.
``(11) Mechanisms to minimize adverse risk selection.--The
manner in which the State will encourage mechanisms to minimize
adverse risk selection that provide choice of health plans and
control costs.
``(12) Limitation on administrative expenditures.--The
manner in which the State will ensure that all qualified plans
in the State expend at least 90 percent (or, during the first 2
years of the plan, 85 percent) of total income received from
premiums on the provision of covered health care benefits (excluding
all costs for marketing, advertising, health plan administration,
profits, or capital accumulation) to individuals.
``(13) Self-employed and multiemployed.--The manner in
which the State will address self-employed individuals and
multiwage earner families.
``(14) Requirement to maintain medicaid benefits.--The
manner in which the State will ensure that individuals who are
eligible for medical assistance under title XIX and who receive
benefits under the expansion phase (phase I) plan shall receive
any items or services that are not available under the
expansion phase (phase I) plan but that are available under the
State medicaid program under title XIX through `wraparound
coverage' under such program.
``(15) Cost containment; risk selection.--What cost
containment strategies the State will employ and how the State
will reduce adverse risk selection.
``(16) Other matters.--Any other matter determined
appropriate by the Secretary.
``(b) Current Level of Coverage.--
``(1) In general.--The Secretary shall develop a
standardized survey approach that provides timely and up-to-
date data to determine the percentage of the population of each
State that is currently covered by a health insurance plan or
program that provides coverage that meets the requirements of
section 2203(a).
``(2) Biannual survey.--The Secretary shall provide for the
conduct of the survey developed under paragraph (1) not less
than biannually to make coverage determinations for purposes of
paragraph (1).
``(3) Use of alternative system.--The Secretary shall
permit a State to utilize an alternative population-based
monitoring system to make determinations with respect to
coverage in the State for purposes of paragraph (1) if the
Secretary determines that such system meets or exceeds the
methodological standards utilized in the survey developed under
paragraph (1).
``(4) Base coverage gap.--For purposes of subsection
(a)(1)(A), the base coverage gap for a State shall be equal to
100 percent of the eligible individuals and families in the
State for the year involved, less the current level of coverage
for those individuals and families for such year as determined
under paragraph (1) or (3).
``(c) Reducing the Level of Uninsured Individuals.--
``(1) In general.--To be eligible to receive funds under
this part, a State shall agree to administer an expansion phase
(phase I) plan with a goal of providing health insurance
coverage for 100 percent of the eligible residents of the State
by not later than 4 years after the date of approval of the
State's expansion phase (phase I) plan.
``(2) Permissible activities.--A State may use amounts
provided under this part for any activities consistent with
this part that are appropriate to enroll individuals in health
plans and health programs to meet the targets contained in the
State plan under subsection (a)(2)(B), including through the
use of direct payments to health plans or, in the case of a
single State plan, directly to providers of services.
``(d) Process for Submission, Approval, and Amendment of Expansion
Phase (Phase I) Plan.--The provisions of section 2106 apply to an
expansion phase (phase I) plan under this part in the same manner as
they apply to a State plan under title XXI, except that no expansion
phase (phase I) plan may be effective earlier than January 1, 2004, and
all expansion phase (phase I) plans must be submitted for approval by
not later than December 31, 2005.
``SEC. 2203. COVERAGE REQUIREMENTS FOR EXPANSION PHASE (PHASE I) PLANS.
``(a) Required Scope of Health Insurance Coverage.--Health
insurance coverage provided under this part shall consist of at least
the benefits provided under the Federal Employees Health Benefits
Program standard Blue Cross/Blue Shield preferred provider option
service benefit plan, described in and offered under section 8903(1) of
part 5, United States Code, plus mental health and substance abuse
treatment benefits parity for all individuals, and benefits for early
and periodic screening and diagnosis services (EPSDT) under section
1905(a)(4)(B) for all individuals under 21 years of age.
``(b) Limitations on Premiums and Cost-Sharing.--
``(1) Description; general conditions.--An expansion phase
(phase I) plan shall include a description, consistent with
this subsection, of the amount (if any) of premiums, cost-
sharing, or other similar charges imposed. Any such charges
shall be imposed pursuant to a public schedule.
``(2) Limitations on premiums and cost-sharing.--
``(A) Individuals and families with income below
150 percent of poverty line.--In the case of an
individual or family whose income is at or below 150
percent of the poverty line--
``(i) the State plan may not impose a
premium; and
``(ii) the total annual aggregate amount of
cost-sharing imposed by a State with respect to
all individuals in a family may not exceed 0.5
percent of the family's income for the year
involved.
``(B) Individuals and families with income between
150 and 300 percent of poverty line.--In the case of an
individual or family whose income exceeds 150 percent
but does not exceed 300 percent of the poverty line--
``(i) the State plan may not impose a
premium that exceeds an amount that is equal
to--
``(I) 20 percent of the average
cost of providing benefits to an
individual (or a family) under this
part in the year involved; or
``(II) 3 percent of the family's
income for the year involved; and
``(ii) the total annual aggregate amount of
premiums and cost-sharing (combined) imposed by
a State with respect to all individuals in a
family may not exceed 5 percent of the family's
income for the year involved.
``(C) Individuals and families with income above
300 percent of poverty line.--In the case of an
individual or family whose income exceeds 300 percent
of the poverty line--
``(i) the State plan may not impose a
premium that exceeds 20 percent of the average
cost of providing benefits to an individual (or
a family of the size involved) under this part
in the year involved; and
``(ii) the total annual aggregate amount of
premiums and cost-sharing (combined) imposed by
a State with respect to all individuals in a
family may not exceed 7 percent of the family's
income for the year involved.
``(D) Self-employed individuals.--The State shall
establish rules for self-employed individuals based on
individual and family income.
``(3) Collection.--The State shall establish procedures for
collecting any premiums, cost-sharing, or other similar charges
imposed under this part. Such procedures shall provide for
annual reconciliations and adjustments.
``(c) Application of Certain Requirements.--
``(1) Restriction on application of preexisting condition
exclusions.--The expansion phase (phase I) plan shall not
permit the imposition of any preexisting condition exclusion
for covered benefits under the plan.
``(2) Choice of plans.--
``(A) In general.--Except as provided in
subparagraph (B), the expansion phase (phase I) plan
shall offer eligible individuals and families a choice
of qualified plans from which to receive benefits under
this part. At least 1 plan shall be a preferred
provider option plan.
``(B) Waiver.--The Secretary--
``(i) may waive the requirement under
subparagraph (A) if determined appropriate; and
``(ii) shall waive such requirement in the
case of a State that establishes a single State
plan.
``SEC. 2204. ALLOTMENTS.
``(a) State Allotments.--
``(1) In general.--With respect to a fiscal year, the
Secretary shall allot to each State with an expansion phase
(phase I) plan approved under this part the amount determined
under paragraph (2) for such State for such fiscal year.
``(2) Determination of cost of coverage.--The amount
determined under this paragraph is the amount equal to--
``(A) the product of--
``(i) the Federal participation rate for
the State as determined under subsection (b)
or, if applicable, the enhanced Federal
participation rate for the State, as determined
under subsection (c);
``(ii) the estimated cost for the minimum
benefits package required to comply under
section 2203, not to exceed the sum of--
``(I) the total annual Government
and employee contributions required for
individual or self and family health
benefits coverage under the Federal
Employees Health Benefits Program
standard Blue Cross/Blue Shield
preferred provider option service
benefit plan, described in and offered
under section 8903(1) of title 5,
United States Code (adjusted for age
and other factors, as the Secretary
determines appropriate); and
``(II) the estimated average cost-
sharing expense for an individual or
family; and
``(iii) the estimated number of residents
to be enrolled in the expansion phase (phase I)
plan; less
``(B) the sum of--
``(i) the individual or family health
insurance contribution and cost-sharing
payments to be made in accordance with section
2203(b); and
``(ii) any applicable employer contribution
to such payments.
``(b) Federal Participation Rate.--For purposes of subsection
(a)(2)(A)(i), the Federal participation rate for a State shall be equal
to the enhanced FMAP determined for the State under section 2105(b).
``(c) Enhanced Federal Participation Rate.--
``(1) In general.--For purposes of subsection (a)(2)(A)(i),
the enhanced Federal participation rate for a State shall be
equal to the Federal participation rate for such State under
subsection (b), as adjusted by the Secretary based on the
decrease in the base coverage gap in the State.
``(2) Amount of adjustment and application.--
``(A) Amount of adjustment.--The Federal
participation rate under subsection (b) with respect to
a State shall be increased by--
``(i) 1 percentage point if the base
coverage gap of the State has decreased by at
least 50 percent within 2 years after the date
of approval of the expansion phase (phase I)
plan, as determined by the Secretary; and
``(ii) 3 percentage points if the base
coverage gap of the State has decreased by 100
percent within 4 years after the date of
approval of the expansion phase (phase I) plan,
as determined by the Secretary.
``(B) Application.--The increase described in--
``(i) subparagraph (A)(i) shall only apply
to a State for the period beginning with the
month of the determination under such
subparagraph and ending with the month
preceding the month of the determination under
subparagraph (A)(ii) (if any), but in no event
for more than 24 months; and
``(ii) subparagraph (A)(ii) shall apply to
a State for any year (or portion thereof)
beginning with the month of the determination
under such subparagraph.
``(3) Full coverage.--For purposes of this part, a State
shall be deemed to have decreased its base coverage gap by 100
percent if the Secretary determines that--
``(A) 98 percent of all eligible residents of the
State are provided health insurance coverage under the
expansion phase (phase I) plan; and
``(B) the remaining 2 percent of such residents are
served by alternative health care delivery systems as
demonstrated by the State.
``(d) Grants to Indian Tribes, Native Hawaiian Organizations, and
Alaska Native Organizations.--
``(1) In general.--Out of funds appropriated under
subsection (e), the Secretary shall reserve an amount, not to
exceed 1 percent of the total allotments determined under
subsection (a) for a fiscal year, to make grants to Indian
tribes, Native Hawaiian organizations, and Alaska Native
organizations for development and implementation of universal
health insurance coverage plans for members of such tribes and
organizations.
``(2) Plan.--To be eligible to receive a grant under
paragraph (1), an Indian tribe, Native Hawaiian organization,
or Alaska Native organization shall submit a universal health
insurance coverage plan to the Secretary at such time, in such
manner, and containing such information, as the Secretary may
require.
``(3) Regulations.--The Secretary shall issue regulations
specifying the requirements of this part that apply to Indian
tribes, Native Hawaiian organizations, and Alaska Native
organizations receiving grants under paragraph (1).
``(e) Appropriation.--
``(1) In general.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to carry out this
title such sums as may be necessary for fiscal year 2004 and
each fiscal year thereafter.
``(2) Budget authority.--Paragraph (1) constitutes budget
authority in advance of appropriations Acts and represents the
obligation of the Federal Government to provide States, Indian
tribes, Native Hawaiian organizations, and Alaska Native
organizations with the allotments determined under this section
and the grants for administrative and outreach activities under
section 2205.
``SEC. 2205. ADMINISTRATION.
``(a) Payments.--
``(1) In general.--
``(A) Quarterly.--Subject to subparagraph (B) and
subsection (b), the Secretary shall make quarterly
payments to each State with an expansion phase (phase
I) plan approved under this part, from its allotment
under section 2204.
``(B) Funding for administration and outreach.--
``(i) Authority to make grants.--In
addition to the allotments determined under
section 2204, the Secretary may make grants to
States, Indian tribes, Native Hawaiian
organizations, and Alaska Native organizations
for expenditures for administrative and
outreach activities.
``(ii) Amounts.--
``(I) In general.--A grant awarded
under this subparagraph shall not
exceed the applicable percentage (as
determined under subclause (II)) of the
total amount allotted to the State,
Indian tribe, Native Hawaiian
organization, or Alaska Native
organization under section 2204.
``(II) Applicable percentage.--For
purposes of subclause (I), the
applicable percentage is--
``(aa) 10 percent for 2005
through 2009; and
``(bb) 3 percent for 2010
and each year thereafter.
``(2) Advance payment; retrospective adjustment.--The
Secretary may make payments under this part for each quarter on
the basis of advance estimates by the State and such other
investigation as the Secretary may find necessary, and may
reduce or increase the payments as necessary to adjust for any
overpayment or underpayment for prior quarters.
``(3) Flexibility in submittal of claims.--Nothing in this
subsection shall be construed as preventing a State from
claiming as expenditures in the quarter expenditures that were
incurred in a previous quarter.
``(b) Authority for Blended Rate for Health Security, Medicaid, and
SCHIP Funds.--The Secretary shall establish procedures for blending the
payments that a State is entitled to receive under this title, title
XIX, and title XXI into 1 payment rate if--
``(1) the State requests such a blended payment; and
``(2) the Secretary finds that the State meets maintenance
of effort requirements established by the Secretary.
``(c) Limitations on Federal Payments Based on Cost Containment.--
``(1) Determination of baseline.--Each year (beginning with
2004), the Secretary shall establish a baseline projection for
the national rate of growth in private health insurance
premiums for such year.
``(2) Requirement.--Beginning with fiscal year 2005 and
each fiscal year thereafter, any payment made to a State under
section 2204 shall not exceed the amount paid to the State
under such section for the preceding fiscal year, adjusted for
changes in enrollment and a premium inflation adjustment that
is 0.5 percent below the baseline projection determined under
paragraph (1) for the year, unless the State adopts (and the
Secretary approves) cost containment strategy that will reduce
the rate of growth of spending.
``(d) Other Limitations on Use of Funds.--
``(1) In general.--A State participating under part A, and,
effective January 1, 2008, all States under part B, shall
ensure that any payments received by the State under section
2205 or 2116(a) are not used by any individual or entity,
including providers or health plans that contract to provide
services herein, to finance directly or indirectly, or to
otherwise facilitate expenditures to influence health care
workers of such individual or entity with respect to issues
related to unionization.
``(2) Construction.--Nothing in this subsection shall be
construed to limit expenditures made for the purpose of good
faith collective bargaining or pursuant to the terms of a bona
fide collective bargaining agreement.
``(e) Waiver of Federal Requirements.--A State may request (and the
Secretary may grant) a waiver of any provision of Federal law that the
State determines is necessary in order to carry out an approved
expansion phase (phase I) plan under this part.
``(f) Report.--Not later than January 1, 2005, and each January 1
thereafter, the Secretary, in consultation with the General Accounting
Office and the Congressional Budget Office, shall prepare and submit to
the appropriate committees of Congress a report on the number of States
receiving payments under this part for the year for which the report is
being prepared as well as the level of insurance coverage attained by
each such State.
``SEC. 2206. DEFINITIONS.
``In this title:
``(1) Cost-sharing.--The term `cost-sharing' has the
meaning given such term under the Federal Employees Health
Benefits Program standard Blue Cross/Blue Shield preferred
provider option service benefit plan described in and offered
under section 8903(1) of part 5, United States Code, and
includes deductibles, copayments, coinsurance, as such terms
are defined for purposes of such plan.
``(2) Eligible residents of a state.--
``(A) In general.--The term `eligible residents of
a State' means an individual or family who--
``(i) is (or consists of) a resident of the
State involved;
``(ii) except as provided in subparagraph
(B), has a family income that does not exceed
300 percent of the poverty line;
``(iii) is (or consists of) a citizen of
the United States, a legal resident alien, or
an individual otherwise residing in the United
States under the authority of Federal law; and
``(iv) in the case of an individual, is not
eligible for benefits under the medicare
program under title XVIII or for medical
assistance under the medicaid program under
title XIX (other than under the application of
section 1902(a)(10)(A)(ii)(XIV)).
``(B) Option to provide coverage for individuals
and families with higher income.--If approved by the
Secretary, a State may increase the percentage
described in subparagraph (A)(ii), or eliminate all
income eligibility criteria in order to provide
coverage under this part to more individuals and
families.
``(3) Expansion phase (phase i) plan.--The term `expansion
phase (phase I) plan' means the State universal health
insurance coverage plan submitted under section 2201(b).
``(4) Health care services.--The term `health care
services' includes medical, surgical, mental health, and
substance abuse services, whether provided on an inpatient or
outpatient basis.
``(5) Health care worker.--The term `health care worker'
means an individual employed by an employer that provides--
``(A) health care services; or
``(B) necessary related services, including
administrative, food service, janitorial, or
maintenance service to an entity that provides such
health care services.
``(6) Health plan.--The term `health plan' includes health
insurance coverage, as defined in section 2791(b)(1) of the
Public Health Service Act (42 U.S.C. 300gg-91(b)(1)) and group
health plans, as defined in section 2791(a) of such Act (42
U.S.C. 300gg91(b)(1)).
``(7) Mental health and substance abuse treatment benefits
parity.--
``(A) In general.--The term `mental health and
substance abuse treatment benefits parity' means, with
respect to health coverage, that the coverage does not
impose treatment limitations or financial requirements
on the coverage of mental health benefits if similar
requirements are not imposed on coverage of medical and
surgical benefits in comparable settings (including
inpatient and outpatient settings).
``(B) Treatment limitations.--The term `treatment
limitations' means limits on the frequency of
treatment, number of visits, or other limits on the
scope and duration of treatment, as covered by a group health plan (or
health insurance coverage offered in connection with such a plan). Such
term does not include limits on benefits or coverage based solely on
medical necessity.
``(C) Financial requirements.--The term `financial
requirements' means copayments, deductibles, out-of-
network charges, out-of-pocket contributions or fees,
annual limits, and lifetime aggregate limits imposed on
covered individuals.
``(8) Poverty line.--The term `poverty line' has the
meaning given such term in section 673(2) of the Community
Services Block Grant Act (42 U.S.C. 9902(2)), including any
revision required by such section.
``(9) Premium.--The term `premium' includes any enrollment
fees and other similar charges.
``(10) Qualified plan.--The term `qualified plan' means a
health plan that satisfies the coverage requirements described
under section 2203 and participates in an expansion phase
(phase I) plan.''.
TITLE II--HEALTH SECURITY FOR ALL AMERICANS--UNIVERSAL PHASE (PHASE II)
SEC. 201. UNIVERSAL PHASE (PHASE II) STATE UNIVERSAL HEALTH INSURANCE
COVERAGE PLANS.
Title XXII of the Social Security Act, as added by section 101, is
amended by adding at the end the following:
``PART B--UNIVERSAL PHASE (PHASE II) PLANS
``SEC. 2211. PURPOSE; MANDATORY STATE PLANS.
``(a) Purpose.--The purposes of this part are to--
``(1) require States to establish and implement State-
administered systems to ensure universal health insurance
coverage; and
``(2) provide funds to States for the establishment and
implementation of such systems.
``(b) Universal Phase (Phase II) Plan Required.--
``(1) In general.--Except as provided in paragraph (2), not
later than January 1, 2007, a State shall submit to the
Secretary a plan that sets forth how the State intends to use
the funds provided under this part to ensure universal,
affordable, and comprehensive health insurance coverage to
eligible residents of the State consistent with the provisions
of this part.
``(2) States with phase i plans.--
``(A) In general.--Not later than January 1, 2007,
a State with a phase I State plan shall submit an
addendum to such plan that provides assurances to the
Secretary that such plan conforms to the requirements
of this part.
``(B) Conversion to universal phase (phase ii)
plan.--If an addendum to an expansion phase (phase I)
plan is approved by the Secretary--
``(i) the plan shall be automatically
converted to a universal phase (phase II) plan;
and
``(ii) section 2214 and any provision of
part A that is inconsistent with this part
shall not apply to the plan.
``(3) Failure to submit plan or addendum.--If a State fails
to submit a plan as required in paragraph (1) (or an addendum
as required in paragraph (2)), or fails to have such plan or
addendum approved by the Secretary, such State shall be in
violation of this part; and any residents of such a State may
bring a cause of action against the State in Federal district
court to require the State to comply with the provisions of
this part.
``SEC. 2212. PLAN REQUIREMENTS.
``(a) In General.--A universal phase (phase II) plan shall include
a description, consistent with the requirements of this part, of the
following:
``(1) Details of the universal phase (phase ii) plan.--The
activities that the State intends to carry out using funds
received under this part to ensure that all eligible residents
of the State have access to the coverage provided under this
part, including how the State will coordinate efforts under the
program under this part with existing State efforts to increase
to 100 percent the health insurance coverage of eligible
residents of the State by January 1, 2009.
``(2) Requirements for employers.--The manner in which the
State will ensure that employers within the State will comply
with the requirements of section 2214.
``(3) Part a provisions.--The following provisions apply to
a universal phase (phase II) plan under this part in the same
manner as such provisions apply to an expansion phase (phase I)
plan under part A:
``(A) State outreach programs; access.--Section
2202(a)(4).
``(B) Assurance of coverage of essential
services.--Section 2202(a)(5).
``(C) Representation on boards and commissions.--
Section 2202(a)(6).
``(D) Disclosure of information to the public.--
Section 2202(a)(7).
``(E) Consumer protections and workforce
standards.--Section 2202(a)(8).
``(F) Public review.--Section 2202(a)(9).
``(G) Services in rural and underserved areas;
cultural competency.--Section 2202(a)(10).
``(H) Purchasing pools.--Section 2202(a)(11).
``(I) Limitation on administrative expenditures.--
Section 2202(a)(12).
``(J) Self-employed and multiemployed.--Section
2202(a)(13).
``(K) Medicaid wraparound coverage.--Section
2202(a)(14).
``(4) Other matters.--Any other matter determined
appropriate by the Secretary.
``(b) Permissible Activities.--A State may use amounts provided
under this part for any activities consistent with this part that are
appropriate to enroll individuals in health plans to ensure that all
eligible residents of the State are provided coverage under this part,
including through the use of direct payments to health plans or
providers of services.
``(c) Cost Containment; Competitive Bidding.--Notwithstanding
subsection (b), State purchasing pools shall solicit bids from health
plans at least annually.
``(d) Process for Submission, Approval, and Amendment of Universal
Phase (Phase II) Plan.--Section 2106 applies to a universal phase
(phase II) plan under this part in the same manner as such section
applies to a State plan under title XXI, except that no universal phase
(phase II) plan may be effective earlier than January 1, 2008, and all
such plans must be submitted for approval by not later than January 1,
2007.
``SEC. 2213. COVERAGE REQUIREMENTS FOR UNIVERSAL PHASE (PHASE II)
PLANS.
``(a) Required Scope of Health Insurance Coverage.--Section 2203(a)
applies to a universal phase (phase II) plan under this part.
``(b) Universal Coverage.--All States shall ensure that by January
1, 2009, 100 percent of eligible residents of the State have health
insurance coverage that meets the requirements of section 2203(a).
``(c) Limitations on Premiums and Cost-Sharing.--Section 2203(b)
applies to a universal phase (phase II) plan under this part.
``(d) Application of Certain Requirements.--Section 2203(c) applies
to a universal phase (phase II) plan under this part.
``SEC. 2214. REQUIREMENTS FOR EMPLOYERS REGARDING THE PROVISION OF
BENEFITS.
``(a) Requirements.--Subject to subsection (c)(2)(B), an employer
in a State shall comply with the following requirements:
``(1) Employers with less than 500 employees.--
``(A) In general.--An employer with less than 500
employees shall enroll each employee in a State-
designated purchasing pool.
``(B) Contributions.--
``(i) In general.--Notwithstanding
subparagraph (A) and subject to clause (ii),
the employer shall make a contribution on
behalf of each employee for health insurance
coverage that is equal to at least 80 percent
of the total premiums for such coverage for
employees and their families if the employee
elects dependent coverage.
``(ii) Limitation.--An employer shall not
be liable under subparagraph (B) for more than
10 percent of each employee's annual wages.
``(2) Employers with at least 500 employees.--
``(A) In general.--An employer with at least 500
employees, a majority of whose wages fall below an
amount equal to 300 percent of the poverty line
applicable to a family of the size involved, shall
comply with the requirements applicable to an employer
under paragraph (1).
``(B) Other employers.--
``(i) In general.--An employer with at
least 500 employees that is not described in
subparagraph (A) shall, at the option of the
employer, either--
``(I) comply with the requirements
applicable to an employer under
paragraph (1); or
``(II) provide health insurance
coverage to all employees and their
families (if the employee elects
dependent coverage) that meets the
requirements of section 2213 and the
employer contribution required under
paragraph (1)(B).
``(ii) Additional employer contribution.--
An employer that elects to comply with clause
(i)(I) shall contribute an additional 1 percent
of payroll into the State-designated purchasing
pool in which it participates.
``(3) Rule of construction.--Nothing in this title shall be
construed as prohibiting a labor organization from collectively
bargaining for an employer contribution that is greater than
the contribution that is required under paragraph (1)(B) or, as
applicable, for health insurance benefits that are greater than
the coverage required under paragraph section 2203(a).
``(4) Part-time employees.--An employer shall be
responsible for meeting the requirements under this subsection
for all employees of the employer.
``(5) Multiemployer families.--In the case of a family with
more than 1 employer, the employers of individuals within the
family shall apportion their contributions in accordance with
rules established by the State.
``(b) Nonapplicability.--This section shall not apply--
``(1) to any State that establishes a single payor system;
or
``(2) to any State that established a universal phase
(phase II) plan through an approved addendum to an expansion
phase (phase I) plan.
``(c) Private Cause of Action.--
``(1) Liability.--An employer that fails to comply with the
requirements of subsection (a) or otherwise takes adverse
action against an employee for the purpose of interfering with
the attainment of any right to which the employee may be
entitled to under this title, shall be liable to the employee
affected.
``(2) Amount.--The amount of the liability described in
paragraph (1) shall be an amount equal to--
``(A) the contributions that otherwise would have
been made by the employer on behalf of the employee
under this section;
``(B) an additional amount as liquidated damages;
and
``(C) consequential damages for reasonably
foreseeable injuries resulting from such action.
``(3) Jurisdiction; equitable relief.--
``(A) Jurisdiction.--An action under this
subsection may be maintained against any employer in
any Federal or State court of competent jurisdiction by
any 1 or more employees.
``(B) Equitable relief.--In addition to the damages
described in paragraph (2), a court may enjoin any act
or practice that violates this title.
``(4) Attorney's fees.--If a plaintiff or plaintiffs
prevail in an action brought under this subsection, the court
shall, in addition to any judgment awarded to the plaintiff or
plaintiffs, award the reasonable attorney's fees and costs
associated with the bringing of the action.
``SEC. 2215. ALLOTMENTS.
``(a) State Allotments.--Subsections (a) and (b) of section 2204
apply to a universal phase (phase II) plan under this part in the same
manner as such subsections apply to an expansion phase (phase I) plan
under part A.
``(b) Special Rule for Expansion Phase (Phase I) Plans.--A State
that operated an expansion phase (phase I) plan and converted such plan
to a universal phase (phase II) plan pursuant to section 2211(b)(2)(B)
shall continue to be eligible for the enhanced Federal participation
rate determined under section 2204(c).
``(c) Grants to Indian Tribes, Native Hawaiian Organizations, and
Alaska Native Organizations.--Section 2204(d) applies to a universal
phase (phase II) plan under this part.
``(d) Appropriation.--
``(1) In general.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated to carry out this
title such sums as may be necessary for fiscal year 2008 and
each fiscal year thereafter.
``(2) Budget authority.--Paragraph (1) constitutes budget
authority in advance of appropriations Acts and represents the
obligation of the Federal Government to provide States, Indian
tribes, Native Hawaiian organizations, and Alaska Native
organizations with the allotments determined under this section
and the grants for administrative and outreach activities under
section 2205(a)(1)(B) (as applied to this part under section
2216(a)).
``SEC. 2216. ADMINISTRATION; DEFINITIONS.
``(a) Administration.--The provisions of section 2205 (other than
subsection (c) of such section) apply to a universal phase (phase II)
plan under this part in the same manner as such provisions apply to an
expansion phase (phase I) plan under part A.
``(b) Definitions.--
``(1) Application of section 2206.--The definitions set
forth in section 2206 apply to a universal phase (phase II)
plan under this part in the same manner as such provisions
apply to an expansion phase (phase I) plan under part A except
that for purposes of this part, the definition of `eligible
residents of a State' set forth in section 2206(2) shall be
applied without regard to subparagraphs (A)(ii) and (B).
``(2) Universal phase (phase ii) plan.--In this title, the
term `universal phase (phase II) plan' means the State
universal health insurance coverage plan submitted under
section 2211(b).''.
SEC. 202. CONSUMER PROTECTIONS.
Title XXII of the Social Security Act, as amended by section 201,
is amended by adding at the end the following:
``PART C--CONSUMER PROTECTIONS
``SEC. 2221. HOME CARE STANDARDS.
``In order to ensure that home care services are provided in a
consumer-directed manner, a State participating under part A, and,
effective January 1, 2008, all States under part B, shall satisfy the
Secretary that any health plan that provides home care services under
this title creates, or contracts with, a viable entity other than the
consumer or individual provider to provide effective billing, payments
for services, tax withholding, unemployment insurance, and workers
compensation coverage, and to serve as the statutory employer of the
home care provider. Recipients of such services shall retain the right
to independently select, hire, terminate, and direct the work of the
home care provider.
``SEC. 2222. CONSUMER PROTECTION IN THE EVENT OF TERMINATION OR
SUSPENSION OF SERVICES.
``A State participating under part A, and, effective January 1,
2008, all States under part B, shall satisfy the Secretary that any
health plan providing services under this title shall ensure that
enrollees will receive continued health services in the event that the
plan's health care services are terminated or suspended, including as
the result of the plan filing for bankruptcy relief under title 11,
United States Code, or the failure of the plan to provide payments to
providers, lockouts, work stoppages, or other labor management
problems.
``SEC. 2223. CONSUMER PROTECTION THROUGH DISCLOSURE OF INFORMATION.
``(a) In General.--A State participating under part A, and,
effective January 1, 2008, all States under part B, shall satisfy the
Secretary that any health care provider that provides services to
individuals under this title shall provide to the State information
regarding the identity, employment location, and qualifications of
health care workers providing services under--
``(1) the licensure of the provider; or
``(2) a contract between the provider and a health plan or
the State.
``(b) Availability to Public.--A health care provider shall make
the information described in subsection (a) available to the public.
``SEC. 2224. CONSUMER PROTECTION THROUGH NOTICE OF CHANGES IN HEALTH
CARE DELIVERY.
``A State participating under part A, and, effective January 1,
2008, all States under part B, shall describe how the State will
provide, at a minimum, the following protections:
``(1) Adequate advance notice to the public, the affected
health care workers, and labor organizations representing such
workers, of a pending--
``(A) facility or operating unit closure;
``(B) sale, merger, or consolidation of a facility
or operating unit;
``(C) transfer of work from 1 facility or entity to
another facility or entity; or
``(D) reduction of services.
``(2) A right of first refusal for similar vacant positions
with--
``(A) the resulting entity, in the case of a health
care worker whose position was eliminated following a
merger of the worker's original employer with a new
entity; or
``(B) the contractor, in the case of a health care
worker whose position was eliminated following the
contracting out of the work the worker formerly
performed.''.
TITLE III--PATIENT PROTECTIONS
SEC. 301. INCORPORATION OF CERTAIN PROTECTIONS.
(a) Incorporation.--The provisions of the following bills are
hereby enacted into law:
(1) S. 1052 of the 107th Congress, as passed by the Senate
on June 29, 2001.
(2) H.R. 2340 of the 107th Congress, as introduced on June
27, 2001.
(b) Publication.--In publishing this Act in slip form and in the
United States Statutes at Large pursuant to section 112, of title 1,
United States Code, the Archivist of the United States shall include
after the date of approval at the end appendixes setting forth the
texts of the bills referred to in subsection (a) of this section.
TITLE IV--HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS
SEC. 401. HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS
INSTITUTE.
(a) Establishment.--
(1) Institute.--There is established within the Agency for
Healthcare Research and Quality, an institute to be known as
the Health Care Quality, Patient Safety, and Workforce
Standards Institute (in this section referred to as the
``Institute'').
(2) Director.--The Secretary of Health and Human Services
shall appoint a director of the Institute. The director shall
administer the Institute and carry out the duties of the
director under this section subject to the authority,
direction, and control of the Secretary.
(b) Mission.--The mission of the Institute is to--
(1) demonstrate how patient safety issues and workplace
conditions are linked to quality patient care and the reduction
of the incidence of medical errors; and
(2) reduce the incidence of medical errors and improve
patient safety and quality of care.
(c) Duties.--In carrying out the mission of the Institute, the
director of the Institute shall--
(1) work closely with the director of the Agency for
Healthcare Research and Quality to ensure that issues related
to workplace conditions are reflected in the activities
conducted by such agency in order to reduce the incidence of
medical errors and improve patient safety and quality of care,
including--
(A) the establishment of national goals;
(B) the development and implementation of a
research agenda;
(C) the development and promotion of best
practices;
(D) the development of performance and staffing
standards in consultation with the Health Care
Financing Administration and other Federal agencies, as
appropriate; and
(E) the development and dissemination of
information, educational and training materials, and
other criteria as it relates to the delivery of quality
care;
(2) provide recommendations to the Secretary of Health and
Human Services and other Federal agencies with responsibility
for health care quality and the development of standards that
impact on the delivery of quality patient care on standards
related to workplace conditions and patient safety;
(3) support the activities of the Health Care Financing
Administration related to the development of new or revised
conditions of participation under the medicare and medicaid
programs and subsequent rulemaking on issues related to
workplace conditions, medical errors, and patient safety and
quality of care; and
(4) conduct other activities determined appropriate by the
director of the Institute.
(d) Workplace Conditions.--For purposes of this section, the term
``workplace conditions'' shall include issues related to--
(1) health care worker staffing;
(2) hours of work;
(3) confidentiality and whistleblower protections;
(4) employee participation in decisionmaking roles that
contribute to improved quality of care and the reduction of the
incidence of medical errors;
(5) workforce training; and
(6) the impact of health care delivery restructuring on
communities and health care workers.
(e) Definition of Health Care Worker.--
(1) In general.--In this section, the term ``health care
worker'' means an individual employed by an employer that
provides--
(A) health care services; or
(B) necessary related services, including
administrative, food service, janitorial, or
maintenance service to an entity that provides such
health care services.
(2) Health care services.--In paragraph (1), the term
``health care services'' includes medical, surgical, mental
health, and substance abuse services, whether provided on an
in-patient or outpatient basis.
(f) Authorization of Appropriations.--There are authorized to be
appropriated to the Institute such sums as may be necessary to carry
out the purposes of this section.
SEC. 402. HEALTH CARE QUALITY, PATIENT SAFETY, AND WORKFORCE STANDARDS
ADVISORY COMMITTEE.
(a) Establishment of Committee.--There is established a Health Care
Quality, Patient Safety, and Workforce Standards Committee (in this
section referred to as the ``Committee'').
(b) Functions of Committee.--
(1) Advice to institute.--The Committee shall provide
advice to the Director of the Health Care Quality, Patient
Safety, and Workforce Standards Institute established under
section 401 on issues related to the duties of the Director.
(2) Initial report.--Not later than December 31, 2004, the
Committee shall submit an initial report to the Secretary that
contains--
(A) recommendations regarding minimal workforce
standards that are critical for improved health care
quality and patient safety; and
(B) recommendations regarding additional ways to
reduce the incidence of medical errors and to improve
patient safety and quality of care.
(3) Final report.--Not later than December 31, 2005, the
Committee shall submit a final report to the Secretary of
Health and Human Services regarding the recommendations
contained in the initial report required under paragraph (2),
including any modifications of such recommendations.
(c) Structure and Membership of the Committee.--
(1) Structure.--The Committee shall be composed of the
Director of the Health Care Quality, Patient Safety, and
Workforce Standards Institute established under section 401 and
15 additional members who shall be appointed by the Secretary
of Health and Human Services.
(2) Membership.--
(A) In general.--The members of the Committee shall
be chosen on the basis of their integrity,
impartiality, and good judgment, and shall be
individuals who are, by reason of their education,
experience, and attainments, exceptionally qualified to
perform the duties of members of the Committee.
(B) Specific members.--In making appointments under
paragraph (1), the Secretary of Health and Human
Services shall ensure that the following groups are
represented:
(i) Health care providers and health care
workers, including labor unions representing
health care workers.
(ii) Consumer organizations.
(iii) Health care institutions.
(iv) Health education organizations.
(d) Chairman.--The Director of the Health Care Quality, Patient
Safety, and Workforce Standards Institute established under section 401
shall chair the Committee.
TITLE V--IMPROVING MEDICARE BENEFITS
SEC. 501. FULL MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT BENEFITS
PARITY.
Notwithstanding any provision of title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.), beginning January 1, 2004, each
individual who is entitled to benefits under part A or enrolled under
part B of the medicare program, including an individual enrolled in a
Medicare+Choice plan offered by a Medicare+Choice organization under
part C of such program, shall be provided full mental health and
substance abuse treatment parity under the medicare program established
under such title of such Act consistent with title XXII of the Social
Security Act (as added by this Act).
TITLE VI--LONG-TERM AND HOME HEALTH CARE
SEC. 601. STUDIES AND DEMONSTRATION PROJECTS TO IDENTIFY MODEL
PROGRAMS.
The Secretary of Health and Human Services shall--
(1) conduct studies and demonstration projects, through
grant, contract, or interagency agreement, that are designed to
identify model programs for the provision of long-term and home
health care services;
(2) report regularly to Congress on the results of such
studies and demonstration projects; and
(3) include in such report any recommendations for
legislation to expand or continue such studies and projects.
TITLE VII--MISCELLANEOUS
SEC. 701. NONAPPLICATION OF ERISA.
The provisions of section 514 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1144) shall not apply with respect to
health benefits provided under a group health plan (as defined in
section 733(a) of that Act (29 U.S.C. 1191b(a))) qualified to offer
such benefits under an expansion phase (phase I) plan under title XXII
of the Social Security Act (as added by this Act) or under a universal
phase (phase II) plan under such title.
SEC. 702. SENSE OF CONGRESS REGARDING OFFSETS.
It is the sense of Congress that any sums necessary for the
implementation of this Act, and the amendments made by this Act, should
be offset by--
(1) general revenues available as a result of an on-budget
surplus for a fiscal year;
(2) direct savings in health care expenditures resulting
from the implementation of this Act; and
(3) reductions in unnecessary Federal tax benefits
available only to individuals and large corporations that are
in the maximum tax brackets.
<all>