1. H.R. 676 United States National Health Insurance Act or Expanded and Improved Medicare for All

2. ELIGIBILITY ● All persons residing in the U.S., including U.S. Territories. ● Individuals and families shall receive a U.S. National Health Insurance card after filling out an application form at a health care provider.

3. Benefits ● Primary Care and Prevention ● Inpatient Care ● Outpatient Care ● Emergency Care ● Prescription Drugs ● Durable Medical Equipment ● Long Term Care ● Mental Health Services ● Dental Services ● Substance Abuse Treatment ● Vision Care ● Chiropractic Care

4. Portability and Cost Sharing ● Benefits Available Anywhere in the United States ● No Deductibles, Co-Pays or Other Cost Sharing ● Patients have Free Choice of Participating Providers and Health Care Facilities

5. Qualifications for Provider Participation ● Must be Not for Profit ● Investor Owned Providers may convert to Non Profit Status ● Funds Authorized to Compensate For Profit Providers who Convert to Non Profit Status ● Conversion to take place over 15 year period ● Compensation only for Real Property and Equipment – Not for Business Profits

6. Quality Standards ● Health Care Facilities must meet Regional and State Quality and Licensing Guidelines ● Clinicians must be Licensed in their State of Practice

7. Participation of Health Maintenance Organizations ● Non Profit HMO's that Actually Deliver Care May Participate ● Funded by Global Budgets or Capitation (per patient) Payments ● HMO's which Contract to Pay for Services Delivered by Non-Employees Shall be Classified as Insurance Plans and May Not Participate

8. Prohibition Against Duplicating Coverage ● No Private Health Insurer May Sell Coverage Duplicating the Benefits of This Plan ● Private Insurers May Offer Benefits Not Covered – Such as Cosmetic Surgery

9. Budgeting ● Budgets are Established on an Annual Basis To Cover: – An Operating Budget – A Capital Expenditures Budget – Reimbursement for Providers – Health Profession Education Budget

10. Operating Budget ● Payment for Services Rendered by Clinicians ● Global Budgets for Institutional Providers ● Capitation Payments for Capitated Groups ● Administration

11. Capital Expenditures Budget ● Funding for Construction or Renovation of Health Facilities ● Funding for Major Equipment Purchases

12. Co-Mingling Operations and Capital Improvement Funds is Prohibited

13. Payment of Health Care Providers ● Global Budgets – Hospitals – Nursing Homes – Other Institutional Providers – Inpatient and Institutional Care Provided by Capitated Groups ● Payment of Physicians and other Practitioners – Fee for Service – Salaries within Institutions receiving Global Budgets, e.g. Hospital Employees – Salaries to Providers and Capitated Groups, e.g. HMO's

14. Mental Health Services ● Covered on the same basis as other conditions ● Community Based Care will be Favored over Institutional Care

15. Prescription & Medical Equipment Coverage ● Will Establish a Drug Formulary ● Generics Medications Promoted ● Formulary Updated Frequently

16. Funding ● Sums Appropriated Shall Be Paid For: ● By Vastly Reducing Paperwork ● By Requiring Bulk Purchasing of Medications ● From Existing Federal Revenue for Health Care (Medicare, Medicaid, Children's Health Insurance Program) ● By Increasing Personal Income Tax on the Top 5 percent Income Earners ● By a Modest Payroll Tax ● By a Small Tax on Stock and Bond Transactions

17. ADMINISTRATION ● The Secretary of Health and Human Services shall appoint a Director. ● The Director shall appoint: – A director for long term care services – A director for mental health services – A director for an Office of Quality Control ● Consults with state and regional directors, and advises Congress, the President, and the Secretary to ensure the highest health care service delivery.

18. REGIONAL ADMINISTRATION ● Regional offices will replace current Medicare regional offices. ● The Director shall appoint regional directors who: – Coordinate funding to physicians and other providers, and – Coordinate reimbursement through a state-based reimbursement system.

19. STATE ADMINISTRATION ● The governor of each state shall appoint a “State Director”who: – Provides annual needs assessment report to the National Board of Universal Quality and Access (to be described) – Oversees placement and purchase of facilities and equipment – Submits global budgets – Recommends reimbursement changes to providers – Establishes quality assurance mechanism – Maintains budget targets

20. FIRST PRIORITY IN RETRAINING AND JOB PLACEMENT Clerical and administrative workers in insurance companies, doctors' offices, hospitals, nursing facilities, and elsewhere, whose jobs are eliminated due to reduced administration, whould have first priority in retraining and job placement in the new system.

21. MEDICAL RECORD SYSTEM ● The Secretary shall create a standardized, confidential electronic patient record system to reduce errors and simplify billing. ● Patients may keep any portion of their personal record separate from the electronic record.

22. NATIONAL BOARD OF UNIVERSAL QUALITY AND ACCESS ● The president will appoint a 15 member board with Senate consent. ● The board consists of: – Health care professionals – Reps. of institutional providers – Health care advocates – Labor union reps. – Citizen patient advocates ● Members serve a 6 year term ● Financial conflicts of interest are prohibited.

23. DUTIES OF THIS BOARD ● Meet twice a year and advise the Secretary and Director to ensure quality, access, and affordability. ● Address specific issues: – Access – Quality improvement – Administrative efficiency – Adequacy of funding – Appropriate reimbursement – Capital expenditure needs – Long-term care – Mental health/subst. Abuse – staffing/working conditions ● Establish universal, best quality standard of care. – Staffing levels – Appropriate use of technology – Design and scope of work – Best practices ● Members compensated as the Medicare Payment and Assessment Commission is currently.

24. ADDITIONAL PROVISIONS ● The VA (Veterans' Affairs) and “IHS” (Indian Health Service will remain independent for 5 years, after which they shall be integrated into the USNHI program. ● This act intends to stress the importance of good public health through prevention of disease. ● This act intends “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.”