Well, has anyone checked out HR 15 (text below) the first salvo in the race for
national health insurance. I'm curious to what others think of the beginnings
of this new legislation. I am especially interested to hear what the direct
access crowd thinks of section 103 (c). It also would be interesting to hear
opinions related to the assumed clumping under the term physiotherapy i.e
section 101 (g) (3).
Jimmie Arceneaux, LOTR
H.R.15 National Health Insurance Act (Introduced in House)
---------------------------------
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (a) Short Title- This Act
may be cited as the `National Health Insurance Act'.
(b) Table of Contents- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings and declaration of purpose.
Sec. 3. Policies of Act.
TITLE I--BENEFITS AND ELIGIBILITY Sec. 101. Classes of personal health
services.
Sec. 102. Availability of benefits.
Sec. 103. How benefits obtained: free choice by patient.
Sec. 104. Eligibility for benefits.
Sec. 105. Provision of benefits for noninsured needy and other
individuals.
TITLE II--PARTICIPATION OF PHYSICIANS, DENTISTS, NURSES, HOSPITALS, AND
OTHERS Sec. 201. Physicians and dentists; specialists.
Sec. 202. Nurses.
Sec. 203. Hospitals.
Sec. 204. Auxiliary services.
Sec. 205. Agreements with individual practitioners, hospitals, and others.
Sec. 206. Agreements with voluntary health insurance and other
organizations.
Sec. 207. Provisions common to all agreements.
Sec. 208. Methods of payments for services.
Sec. 209. Amount of payments for services.
Sec. 210. Professional rights and responsibilities.
TITLE III--LOCAL ADMINISTRATION Sec. 301. Decentralization of
administration.
Sec. 302. Local administrative committee or officer.
Sec. 303. Local area committees.
Sec. 304. Local professional committees.
Sec. 305. Methods of administration.
TITLE IV--STATE ADMINISTRATION Sec. 401. Declaration of policy.
Sec. 402. State plan of operations.
TITLE V--NATIONAL HEALTH INSURANCE BOARD; NATIONAL ADVISORY MEDICAL POLICY
COUNCIL; GENERAL ADMINISTRATIVE PROVISIONS Sec. 501. National Health
Insurance Board.
Sec. 502. Advisory Council.
Sec. 503. Studies, recommendations, and reports.
Sec. 504. Nondisclosure of information.
Sec. 505. Prohibition against discrimination.
TITLE VI--ELIGIBILITY DETERMINATIONS, COMPLAINTS, HEARINGS, AND JUDICIAL
REVIEW Sec. 601. Determinations as to eligibility for benefits.
Sec. 602. Complaints of eligible individuals and of persons furnishing
benefits.
TITLE VII--APPLICATION OF ACT TO INDIVIDUALS COVERED UNDER MEDICARE PROGRAM
Sec. 701. Eligibility; benefits available.
Sec. 702. Study and report.
TITLE VIII--FISCAL PROVISIONS Sec. 801. Use of Trust Fund.
Sec. 802. Allotment of funds.
Sec. 803. Grants-in-aid for training and education.
TITLE IX--MISCELLANEOUS PROVISIONS Sec. 901. Definitions.
Sec. 902. Effective date.
TITLE X--VALUE ADDED TAX AND NATIONAL HEALTH CARE TRUST FUND Sec.
1001. Imposition of value added tax.
Sec. 1002. Revenue from value added tax to fund National Health Care
Trust Fund.
TITLE XI--STUDY AND DEVELOPMENT OF COST CONTROL MECHANISMS Sec. 1101.
Development of cost control mechanisms.
SEC. 2. FINDINGS AND DECLARATION OF PURPOSE. (a) Findings- The Congress
finds that--
(1) the health of the Nation's people is the foundation of our Nation's
strength, productivity, and wealth;
(2) the assurance of adequate medical care to all of our people is
essential to the general welfare and to the Nation's security;
(3) since the tremendous advances in medical science in recent years have
necessarily meant great advances in the cost of health services, our archaic
system of paying for medical care--based on public and private charity for the
poor, on unpredictable and often unbearable costs to the otherwise
self-supporting, and on disproportionate charges for the well-to-do--has
resulted in the following conditions:
(A) the inability of the vast majority of our people to meet the
shattering cost of serious or chronic illness;
(B) the inability of most of our people to benefit from modern
preventive medicine; and
(C) wholly inadequate provision for the health needs of our farm
families and agricultural workers;
(4) the conditions described in the preceding paragraph cannot
effectively be remedied under the present system of payment for medical care,
or under any voluntary insurance system; and
(5) a medical dole as an answer to this problem is repugnant to the
American people and would certainly result in a system of state medicine, paid
for from tax funds and rendered by regimented doctors.
(b) Purposes- The Congress declares the purposes of this Act to be to
provide a sound economic foundation for our free system of medicine and to
correct the maldistribution of health personnel and facilities by establishing
a system of prepaid personal health insurance on the principle of social
insurance.
SEC. 3. POLICIES OF ACT. (a) In General- In establishing a system of
national health insurance, it is the policy of this Act that--
(1) those persons and their dependents who are insured under the
provisions of the Act shall be assured full freedom to choose their physicians
and to change their choice as they may desire;
(2) physicians and other professions furnishing services in accordance
with the provisions of this Act shall be assured full freedom in the practice
of their professions, including the right to accept or reject patients except
as this right may be restricted by their own professional ethics or by the laws
of the several States; and
(3) the administration of this Act shall be based upon the American
principle of decentralization.
(b) Administrative Responsibilities- In carrying out these policies, it is
the intention of Congress that the major administrative responsibilities be
placed in the hands of local bodies representing both those who pay for and
receive services and those who render services, and operating within the
framework of plans made by the several States, and approved by the Federal
agency; that the National Health Care Trust Fund created by this Act shall be
allotted equitably among the several States and by the States to their local
areas; that voluntary as well as governmental organizations shall be recognized
and utilized; and that all eligible individuals and their dependents as
specified in this Act shall be entitled to its benefits without discrimination
because of race, color, or creed.
TITLE I--BENEFITS AND ELIGIBILITY SEC. 101. CLASSES OF PERSONAL HEALTH
SERVICES. (a) Personal Health Services-
(1) IN GENERAL- The personal health services to be made available as
benefits to eligible individuals as provided in this title are the following:
(A) Medical services.
(B) Dental services.
(C) Podiatric services.
(D) Home-nursing services.
(E) Hospital services.
(F) Auxiliary services.
(2) PROVISION OF SERVICES- Each class of services shall be provided by
persons (including individuals, partnerships, corporations, associations,
consumer cooperatives, and other organizations) who are authorized by
applicable State law, and who are qualified under title II, to do so.
(b) Medical Services- Medical services consist of--
(1) general medical services such as can be rendered by a physician
engaged in the general or family practice of medicine, including preventive,
diagnostic, and therapeutic care and periodic medical examinations; and
(2) specialist services rendered by a physician who is a specialist in
the class of services rendered, as defined in section 201.
Such medical services may be rendered at the office, home, hospital, or
elsewhere, as necessary.
(c) Dental Services- Dental services consist of--
(1) general dental services rendered by a dentist engaged in the general
practice of dentistry, including preventive, diagnostic, and therapeutic care,
and periodic dental examinations; and
(2) specialist services rendered by a dentist who is a specialist in the
class of services rendered, as defined in section 201.
Such dental services may be rendered at the office, home, hospital, or
elsewhere, as necessary.
(d) Podiatric Services- Podiatric services consist of those professional
services of a podiatrist who is legally authorized to perform such services in
the State in which the podiatrist practices.
(e) Home-Nursing Services- Home-nursing services consist of nursing care of
the sick rendered in the home by a registered professional nurse or a qualified
practical nurse.
(f) Hospital Services-
(1) IN GENERAL- Hospital services consist of hospitalization, including
necessary nursing services, and such physician, laboratory, ambulance, and
other services in connection with hospitalization as the National Health
Insurance Board (in this Act referred to as the `Board'), after consultation
with the National Advisory Medical Policy Council (in this Act referred to as
the `Advisory Council'), by regulation designates as essential to good hospital
care, for a maximum of 60 days in any benefit year.
(2) EXCLUSION- Hospital services shall not include hospitalization in a
mental disease hospital or institution, or hospitalization for any day more
than 30 days following the diagnosis of a psychosis.
(3) INCREASE IN MAXIMUM NUMBER OF DAYS- Whenever the Board, after
consultation with the Advisory Council, finds that moneys in the National
Health Care Trust Fund are adequate and that facilities are available, it may
by regulation increase the maximum days of hospitalization in any benefit year.
(g) Auxiliary Services- Auxiliary services consist of such--
(1) chemical, bacteriological, pathological, diagnostic X-ray and related
laboratory services;
(2) X-ray, radium, and related therapy;
(3) physiotherapy;
(4) services of optometrists;
(5) prescribed drugs which are unusually expensive;
(6) special appliances; and
(7) eyeglasses;
as the Board, after consultation with the Advisory Council, by regulation
designates as auxiliary services on the basis of its finding that their
provision under this Act is practicable and is essential to good health care.
SEC. 102. AVAILABILITY OF BENEFITS. (a) General Availability-
(1) IN GENERAL- Medical services, hospital services, and, except as
otherwise provided in subsection (b), all other personal health services
specified in section 101 shall be made available (subject to section 701) as
benefits to eligible individuals in all health-service areas within the United
States as rapidly and as completely as possible having regard for the
availability of the professional and technical personnel and the hospital and
other facilities needed to provide such services.
(2) SURVEYS OF RESOURCES AND NEEDS- To this end the resources and needs
of each State shall be surveyed and a program developed in each State to assure
the maximum participation and use of health personnel and facilities in the
provision of benefits, and to encourage improvement in the number and
distribution of such personnel and facilities throughout the State. Additional
surveys shall be undertaken as required, and the program in the State from time
to time modified on the basis thereof.
(b) Limitation on Availability- If the Board, after consultation with the
Advisory Council, finds that the personnel or facilities or funds that are or
can be made available are inadequate to insure the provision of all services
included as dental, home-nursing, or auxiliary services under section 101, it
may by regulation limit for a specified period the services which may be
provided as benefits, or modify the extent to which, or the circumstances under
which, they will be provided to eligible individuals. Any such restriction or
limitation shall be reduced or withdrawn as rapidly as may be practicable. In
the case of dental services, priority in the reduction or withdrawal of any
such restriction or limitation shall be given to children.
(c) Recommendations- The Board shall have the duty of--
(1) studying and making recommendations as to needed services and
facilities for the care of the chronic sick afflicted with physical ailments,
and for the care of individuals afflicted with mental or nervous diseases, and
as to needed provisions for the prevention of chronic physical diseases and of
mental or nervous diseases; and
(2) making reports from time to time, with recommendations as to
legislation, but the first such report shall be made not later than two years
after benefits under this Act first become available.
SEC. 103. HOW BENEFITS OBTAINED: FREE CHOICE BY PATIENT. (a) In General-
Every individual eligible for personal health services available under this Act
may freely select the physician, dentist, podiatrist, nurse, medical group,
hospital, or other person of the individual's choice to render such services,
and may change such selection if the practitioner, medical group, hospital, or
other person has agreed under title II to furnish the class of services
required and consents to furnish such services to the individual.
(b) Practitioner Services- General medical, dental, and podiatric services
may be obtained by request made by the individual directly to the practitioner
of the individual's choice.
(c) Specialty Services- Specialist, home-nursing, hospital, and auxiliary
services shall be obtained from the specialist, nurse, hospital, or other
person of the individual's choice, whenever the practitioner from whom the
individual is receiving medical or dental services as benefits under this Act
refers the individual for specialist, home-nursing, hospital, or auxiliary
services upon determining that such services are required in the proper care of
the individual's particular case; or whenever, upon request of the individual,
an administrative medical officer, upon a like determination, refers the
individual for such services.
(d) Waiver of Referral- The Board, by regulation, shall dispense with the
necessity of referral in cases of emergency, and may dispense with the
necessity of referral under specified circumstances or as respects specified
classes of services, or both, if it finds, after consultation with the Advisory
Council, that such action will be conducive to the provision of a more adequate
amount and quality of health care and will not unreasonably increase the
expenditures from the National Health Care Trust Fund for such services.
SEC. 104. ELIGIBILITY FOR BENEFITS. (a) In General- Subject to section
701, every individual shall be eligible for benefits under this Act throughout
any benefit year if the individual--
(1) has received (or, in the case of income from self-employment, has
accrued)--
(A) not less than $2,000 in wages during the first four of the last six
calendar quarters preceding the beginning of the benefit year; or
(B) not less than $1,500 in wages in each of six calendar quarters
during the first twelve of the last fourteen calendar quarters preceding the
beginning of the benefit year (not counting as one of such fourteen calendar
quarters any quarter in any part of which the individual was under a total
disability which continued for six months or more);
(2) is entitled, for the first month in the benefit year, to a benefit
under title II of the Social Security Act or to an annuity under subchapter III
(relating to civil service retirement) of chapter 83 of title 5, United States
Code; or
(3) the individual is on the first day of the benefit year a dependent of
an individual who is eligible under paragraph (1) or paragraph (2).
(b) Additional Eligibility- Subject to section 701, every individual, not
eligible therefor under subsection (a), shall be eligible for benefits under
this Act during the remainder of a benefit year, beginning with--
(1) the first day of any calendar quarter in such benefit year, if the
individual has received (or, in the case of income from self-employment, has
accrued) not less than $150 in wages during the first four of the last six
calendar quarters preceding the beginning of such calendar quarter;
(2) the first day of the first month in such benefit year for which the
individual is entitled to a benefit or annuity referred to in subsection
(a)(2); or
(3) the first day in such benefit year on which the is or becomes a
dependent of an individual who is eligible for benefits under subsection (a)
(1) or (2) under paragraph (1) or (2).
(c) Coverage Under Workers' Compensation-
(1) NO COVERAGE- No individual shall be deemed eligible for any personal
health services as a benefit under this Act which are required by reason of any
injury, disease, or disability on account of which any medical, dental,
home-nursing, hospital, or auxiliary service is being received, or upon
application therefor would be received, under a workmen's compensation law of
the United States or of any State, unless equitable reimbursements to the
National Health Care Trust Fund for the provision of such services as benefits
have been made or assured under section 105.
(2) SUBROGATION- In any case in which an individual receives any personal
health service as a benefit under this Act with respect to any such injury,
disease, or disability, for which no reimbursement to the National Health Care
Trust Fund has been made or assured, the United States shall to the extent
permitted by State law be subrogated to all rights of such individual, or of
the person who furnished such service, to be paid or reimbursed, pursuant to
such workmen's compensation law, for the cost of furnishing such service.
SEC. 105. PROVISION OF BENEFITS FOR NONINSURED NEEDY AND OTHER INDIVIDUALS.
(a) In General- Subject to section 701, any or all benefits provided under
this Act to individuals eligible for such benefits may be furnished to
individuals (including the needy) not otherwise eligible therefor, for any
period for which equitable reimbursements to the National Health Care Trust
Fund on behalf of such needy or other individuals have been made, or for which
reasonable assurance of such reimbursements have been given, by public agencies
of the United States, the several States, or any of them or of their political
subdivisions, such reimbursements to be in accordance with agreements and
working arrangements negotiated with such public agencies.
---------------------------------
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