[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 676 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 676
To provide for comprehensive health insurance coverage for all United
States residents, improved health care delivery, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 13, 2013
Mr. Conyers (for himself, Mr. Nadler, Ms. Schakowsky, Ms. Pingree of
Maine, Mr. Grijalva, Mr. Ellison, Mr. Johnson of Georgia, Ms. Eddie
Bernice Johnson of Texas, Mr. Takano, Ms. Norton, Ms. Lofgren, Mr.
Rangel, Ms. Moore, Ms. Chu, Mr. Al Green of Texas, Mr. Farr, Mr.
McGovern, Mr. Welch, Ms. Clarke, Ms. Lee of California, Mr. Nolan, Mr.
Pocan, Mr. Doyle, Mr. Engel, Mr. Gutierrez, Ms. Wilson of Florida, Mr.
Cohen, Ms. Edwards, Mr. McDermott, Mr. Clay, Mr. Huffman, Ms. Roybal-
Allard, Mr. Cummings, Mr. Yarmuth, Mr. George Miller of California, Mr.
Honda, Mrs. Christensen, and Mr. Rush) introduced the following bill;
which was 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
_______________________________________________________________________
A BILL
To provide for comprehensive health insurance coverage for all United
States residents, improved health care delivery, and for other
purposes.
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 ``Expanded &
Improved Medicare For All Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions and terms.
TITLE I--ELIGIBILITY AND BENEFITS
Sec. 101. Eligibility and registration.
Sec. 102. Benefits and portability.
Sec. 103. Qualification of participating providers.
Sec. 104. Prohibition against duplicating coverage.
TITLE II--FINANCES
Subtitle A--Budgeting and Payments
Sec. 201. Budgeting process.
Sec. 202. Payment of providers and health care clinicians.
Sec. 203. Payment for long-term care.
Sec. 204. Mental health services.
Sec. 205. Payment for prescription medications, medical supplies, and
medically necessary assistive equipment.
Sec. 206. Consultation in establishing reimbursement levels.
Subtitle B--Funding
Sec. 211. Overview: funding the Medicare For All Program.
Sec. 212. Appropriations for existing programs.
TITLE III--ADMINISTRATION
Sec. 301. Public administration; appointment of Director.
Sec. 302. Office of Quality Control.
Sec. 303. Regional and State administration; employment of displaced
clerical workers.
Sec. 304. Confidential electronic patient record system.
Sec. 305. National Board of Universal Quality and Access.
TITLE IV--ADDITIONAL PROVISIONS
Sec. 401. Treatment of VA and IHS health programs.
Sec. 402. Public health and prevention.
Sec. 403. Reduction in health disparities.
TITLE V--EFFECTIVE DATE
Sec. 501. Effective date.
SEC. 2. DEFINITIONS AND TERMS.
In this Act:
(1) Medicare for all program; program.--The terms
``Medicare For All Program'' and ``Program'' mean the program
of benefits provided under this Act and, unless the context
otherwise requires, the Secretary with respect to functions
relating to carrying out such program.
(2) National board of universal quality and access.--The
term ``National Board of Universal Quality and Access'' means
such Board established under section 305.
(3) Regional office.--The term ``regional office'' means a
regional office established under section 303.
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(5) Director.--The term ``Director'' means, in relation to
the Program, the Director appointed under section 301.
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
Medicare For All 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
Medicare For All Program Card in the mail, after filling out a Medicare
For All Program 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 Medicare For All Program 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 Medicare For All 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) Approved dietary and nutritional therapies.
(3) Inpatient care.
(4) Outpatient care.
(5) Emergency care.
(6) Prescription drugs.
(7) Durable medical equipment.
(8) Long-term care.
(9) Palliative care.
(10) Mental health services.
(11) The full scope of dental services, services, including
periodontics, oral surgery, and endodontics, but not including
cosmetic dentistry.
(12) Substance abuse treatment services.
(13) Chiropractic services, not including electrical
stimulation.
(14) Basic vision care and vision correction (other than
laser vision correction for cosmetic purposes).
(15) Hearing services, including coverage of hearing aids.
(16) 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 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 Medicare For All 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 Medicare For All 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 Medicare For
All 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 Medicare For All 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 MEDICARE FOR ALL PROGRAM.
(a) In General.--The Medicare For All Program is to be funded as
provided in subsection (c)(1).
(b) Medicare For All Trust Fund.--There shall be established a
Medicare For All 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 Medicare For
All 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 modest tax on unearned income.
(E) 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 medicare for all
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.
TITLE III--ADMINISTRATION
SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DIRECTOR.
(a) In General.--Except as otherwise specifically provided, this
Act shall be administered by the Secretary through a Director appointed
by the Secretary.
(b) Long-Term Care.--The Director shall appoint a director for
long-term care who shall be responsible for administration of this Act
and ensuring the availability and accessibility of high quality long-
term care services.
(c) Mental Health.--The Director shall appoint a director for
mental health who shall be responsible for administration of this Act
and ensuring the availability and accessibility of high quality mental
health services.
SEC. 302. OFFICE OF QUALITY CONTROL.
The Director shall appoint a director for an Office of Quality
Control. Such director shall, after consultation with state and
regional directors, provide annual recommendations to Congress, the
President, the Secretary, and other Program officials on how to ensure
the highest quality health care service delivery. The director of the
Office of Quality Control shall conduct an annual review on the
adequacy of medically necessary services, and shall make
recommendations of any proposed changes to the Congress, the President,
the Secretary, and other Medicare For All Program officials.
SEC. 303. REGIONAL AND STATE ADMINISTRATION; EMPLOYMENT OF DISPLACED
CLERICAL WORKERS.
(a) Establishment of Medicare For All Program Regional Offices.--
The Secretary shall establish and maintain Medicare For All regional
offices for the purpose of distributing funds to providers of care.
Whenever possible, the Secretary should incorporate pre-existing
Medicare infrastructure for this purpose.
(b) Appointment of Regional and State Directors.--In each such
regional office there shall be--
(1) one regional director appointed by the Director; and
(2) for each State in the region, a deputy director (in
this Act referred to as a ``State Director'') appointed by the
governor of that State.
(c) Regional Office Duties.--Regional offices of the Program shall
be responsible for--
(1) coordinating funding to health care providers and
physicians; and
(2) coordinating billing and reimbursements with physicians
and health care providers through a State-based reimbursement
system.
(d) State Director's Duties.--Each State Director shall be
responsible for the following duties:
(1) Providing an annual state health care needs assessment
report to the National Board of Universal Quality and Access,
and the regional board, after a thorough examination of health
needs, in consultation with public health officials,
clinicians, patients, and patient advocates.
(2) Health planning, including oversight of the placement
of new hospitals, clinics, and other health care delivery
facilities.
(3) Health planning, including oversight of the purchase
and placement of new health equipment to ensure timely access
to care and to avoid duplication.
(4) Submitting global budgets to the regional director.
(5) Recommending changes in provider reimbursement or
payment for delivery of health services in the State.
(6) Establishing a quality assurance mechanism in the State
in order to minimize both under utilization and over
utilization and to assure that all providers meet high quality
standards.
(7) Reviewing program disbursements on a quarterly basis
and recommending needed adjustments in fee schedules needed to
achieve budgetary targets and assure adequate access to needed
care.
(e) First Priority in Retraining and Job Placement; 2 Years of
Salary Parity Benefits.--The Program shall provide that clerical,
administrative, and billing personnel in insurance companies, doctors
offices, hospitals, nursing facilities, and other facilities whose jobs
are eliminated due to reduced administration--
(1) should have first priority in retraining and job
placement in the new system; and
(2) shall be eligible to receive two years of Medicare For
All employment transition benefits with each year's benefit
equal to salary earned during the last 12 months of employment,
but shall not exceed $100,000 per year.
(f) Establishment of Medicare For All Employment Transition Fund.--
The Secretary shall establish a trust fund from which expenditures
shall be made to recipients of the benefits allocated in subsection
(e).
(g) Annual Appropriations to Medicare For All Employment Transition
Fund.--Sums are authorized to be appropriated annually as needed to
fund the Medicare For All Employment Transition Benefits.
(h) Retention of Right to Unemployment Benefits.--Nothing in this
section shall be interpreted as a waiver of Medicare For All Employment
Transition benefit recipients' right to receive Federal and State
unemployment benefits.
SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD SYSTEM.
(a) In General.--The Secretary shall create a standardized,
confidential electronic patient record system in accordance with laws
and regulations to maintain accurate patient records and to simplify
the billing process, thereby reducing medical errors and bureaucracy.
(b) Patient Option.--Notwithstanding that all billing shall be
preformed electronically, patients shall have the option of keeping any
portion of their medical records separate from their electronic medical
record.
SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND ACCESS.
(a) Establishment.--
(1) In general.--There is established a National Board of
Universal Quality and Access (in this section referred to as
the ``Board'') consisting of 15 members appointed by the
President, by and with the advice and consent of the Senate.
(2) Qualifications.--The appointed members of the Board
shall include at least one of each of the following:
(A) Health care professionals.
(B) Representatives of institutional providers of
health care.
(C) Representatives of health care advocacy groups.
(D) Representatives of labor unions.
(E) Citizen patient advocates.
(3) Terms.--Each member shall be appointed for a term of 6
years, except that the President shall stagger the terms of
members initially appointed so that the term of no more than 3
members expires in any year.
(4) Prohibition on conflicts of interest.--No member of the
Board shall have a financial conflict of interest with the
duties before the Board.
(b) Duties.--
(1) In general.--The Board shall meet at least twice per
year and shall advise the Secretary and the Director on a
regular basis to ensure quality, access, and affordability.
(2) Specific issues.--The Board shall specifically address
the following issues:
(A) Access to care.
(B) Quality improvement.
(C) Efficiency of administration.
(D) Adequacy of budget and funding.
(E) Appropriateness of reimbursement levels of
physicians and other providers.
(F) Capital expenditure needs.
(G) Long-term care.
(H) Mental health and substance abuse services.
(I) Staffing levels and working conditions in
health care delivery facilities.
(3) Establishment of universal, best quality standard of
care.--The Board shall specifically establish a universal, best
quality of standard of care with respect to--
(A) appropriate staffing levels;
(B) appropriate medical technology;
(C) design and scope of work in the health
workplace;
(D) best practices; and
(E) salary level and working conditions of
physicians, clinicians, nurses, other medical
professionals, and appropriate support staff.
(4) Twice-a-year report.--The Board shall report its
recommendations twice each year to the Secretary, the Director,
Congress, and the President.
(c) Compensation, etc.--The following provisions of section 1805 of
the Social Security Act shall apply to the Board in the same manner as
they apply to the Medicare Payment Assessment Commission (except that
any reference to the Commission or the Comptroller General shall be
treated as references to the Board and the Secretary, respectively):
(1) Subsection (c)(4) (relating to compensation of Board
members).
(2) Subsection (c)(5) (relating to chairman and vice
chairman).
(3) Subsection (c)(6) (relating to meetings).
(4) Subsection (d) (relating to director and staff; experts
and consultants).
(5) Subsection (e) (relating to powers).
TITLE IV--ADDITIONAL PROVISIONS
SEC. 401. TREATMENT OF VA AND IHS HEALTH PROGRAMS.
(a) VA Health Programs.--This Act provides for health programs of
the Department of Veterans' Affairs to initially remain independent for
the 10-year period that begins on the date of the establishment of the
Medicare For All Program. After such 10-year period, the Congress shall
reevaluate whether such programs shall remain independent or be
integrated into the Medicare For All Program.
(b) Indian Health Service Programs.--This Act provides for health
programs of the Indian Health Service to initially remain independent
for the 5-year period that begins on the date of the establishment of
the Medicare For All Program, after which such programs shall be
integrated into the Medicare For All Program.
SEC. 402. PUBLIC HEALTH AND PREVENTION.
It is the intent of this Act that the Program at all times stress
the importance of good public health through the prevention of
diseases.
SEC. 403. REDUCTION IN HEALTH DISPARITIES.
It is the intent of this Act to reduce health disparities by race,
ethnicity, income and geographic region, and to provide high quality,
cost-effective, culturally appropriate care to all individuals
regardless of race, ethnicity, sexual orientation, or language.
TITLE V--EFFECTIVE DATE
SEC. 501. EFFECTIVE DATE.
Except as otherwise specifically provided, this Act shall take
effect on the first day of the first year that begins more than 1 year
after the date of the enactment of this Act, and shall apply to items
and services furnished on or after such date.
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