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HR 676 Information

Conyers Explanation Expanded Medicare for All HR 676

Downloaded from; condensed by Bob Alexander, 517-351-0965


Dear Friends,

U.S. health care is rich in resources. Hospitals and sophisticated equipment abound; even many rural areas boast well-equipped facilities. Most physicians and nurses are superbly trained; dedication to patients the norm. Our research output is prodigious. And we fund health care far more generously than any other nation. Yet despite medical abundance, care is too often meager because of the irrationality of the present health care system.

This is why I have introduced H.R. 676: U.S. National Health Insurance Act, which establishes a new American national health insurance program by creating a single payer health care system. The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and cost effective health care services regardless of one's employment, income, or health care status.

Sincerely, John Conyers


H.R. 676 The United States National Health Insurance Act


Fighting for Health Care for All: National Health Insurance is not only the best

Answer, it is the only answer to begin eliminating Health Disparities-

John Conyers, State of the Black Union, 2005


In 2003, Rep Conyers introduced HR 676, The United States National Health Insurance Act, co-sponsored by Dennis Kucinich, (D- OH), Jim McDermott, (D-WA, and Donna Christensen (D-VI). The bill currently has 37 co-sponsors. Under HR 676, Medicare is extended and improved so that all individuals residing in the United States would receive high quality and affordable health care services. They would get a national health insurance card, and receive all medically necessary services by the physicians of their choice, with no restrictions on what providers they could visits. This includes primary care, dental, mental health, prescription drugs, and long term care. The following is a brief summary of the legislation.

Summery of HR 676 - Who is Eligible - Benefits/Portability

Conversion To A Non-Profit Health Care System

Cost Containment Provisions/ Reimbursement

Administration - Proposed Funding For USNHI Program

Brief Summary of HR 676:


The United States National Health Insurance Act establishes an American a single payer health care system. The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and cost effective health care services regardless of one’s employment, income, or health care status.

With over 43 million uninsured Americans, and another 50 million who are under insured, the time has come to change our inefficient and costly fragmented health care system.

Physicians For A National Health Program reports that under a Medicare For All plan, we could save over $286 billion dollars a year in total health care costs. Previous Medicare For All studies concluded that an average family of three would pay a total of $739.00 annually in total health care costs. Under HR 676, a family of three making $40,000 per year would spend approximately $1600 per year for health care coverage. Annual family premiums have increased upwards to $9,068 this year.

Who is Eligible

Every person living in the United States and the U.S. Territories would receive a United States National Health Insurance Card and ID number once they enroll at the appropriate location. Social Security numbers may not be used when assigning ID cards. No co-pays or deductibles are permissible under this act.


This program will cover all medically necessary services, including primary care, in patient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices.

Conversion To A Non-Profit Health Care System

Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the USNHI program. They shall not be prohibited from selling coverage for any additional benefits not covered by this Act; examples include cosmetic surgery, and other medically unnecessary treatments.

Cost Containment Provisions/ Reimbursement

The National USNHI program will annually set reimbursement rates for physicians, health care providers; and negotiate prescription drug prices. The national office will provide an annual lump sum allotment to each existing Medicare region, which will then administer the program. Payment to health care providers include fee for service, and global budgets.

The conversion to a not-for- profit health care system will take place over a 15 year period, through the sale of U.S. treasury bonds; payment will not be made for loss of business profits, but only for real estate, buildings, and equipment.



The United States Congress will establish annual funding outlays for the USNHI Program through an annual entitlement, and be administered by the Medicare program. A National USNHI Advisory Board will be established, comprised primarily of health care professionals and representatives of health advocacy groups.

Proposed Funding For USNHI Program:

Maintaining current federal and state funding of existing health care programs. A modest payroll tax on all employers of 3.3%. A 5% health tax on the top 5% of income earners. A small tax on stock and bond transfers. Closing corporate tax loop-holes, repealing the Bush tax cut.

It estimated that the USNHI would reduce health spending in 2005 from $1,918 billion to 1,861.3 billion. Over-all government spending would be reduced by 56 billion while covering all of the uninsured. In 2005, without reform, the average employer that offers coverage will contribute $2,600 to health care per employee (for much skimpier benefits). Under this proposal, the average costs to employers for an employee making $30,000 per year will be reduced to $1,155 per year, less than $100 per month.


* For more information, contact Joel Segal, Rep. John Conyers, at (202) 225-5126.

* For the Text of HR 676 Medicare for All US National Health Insurance Act


Current Co-sponsors H.R.676

Title: To provide for comprehensive health insurance coverage for all United States residents, and for other purposes.

Sponsor: Rep Conyers, John, Jr. [MI-14] (introduced 2/8/2005) Cosponsors (62)

Latest Major Action: 4/4/2005 Referred to House subcommittee.

Status: Referred to the Subcommittee on Health.



Rep Abercrombie, Neil [HI-1] - 5/5/2005

Rep Baldwin, Tammy [WI-2] - 5/10/2005

Rep Becerra, Xavier [CA-31] - 11/17/2005

Rep Brown, Corrine [FL-3] - 11/15/2005

Rep Capuano, Michael E. [MA-8] - 12/13/2005

Rep Carson, Julia [IN-7] - 6/7/2005

Rep Christensen, Donna M. [VI] - 2/8/2005

Rep Clay, Wm. Lacy [MO-1] - 5/10/2005

Rep Cummings, Elijah E. [MD-7] - 5/5/2005

Rep Davis, Danny K. [IL-7] - 5/26/2005

Rep Delahunt, William D. [MA-10] - 12/15/2005

Rep Engel, Eliot L. [NY-17] - 6/7/2005

Rep Evans, Lane [IL-17] - 6/7/2005

Rep Farr, Sam [CA-17] - 5/5/2005

Rep Fattah, Chaka [PA-2] - 5/17/2005

Rep Filner, Bob [CA-51] - 4/5/2005

Rep Frank, Barney [MA-4] - 5/18/2005

Rep Grijalva, Raul M. [AZ-7] - 5/25/2005

Rep Gutierrez, Luis V. [IL-4] - 5/18/2005

Rep Hastings, Alcee L. [FL-23] - 6/13/2005

Rep Hinchey, Maurice D. [NY-22] - 5/5/2005

Rep Honda, Michael M. [CA-15] - 6/22/2005

Rep Jackson, Jesse L., Jr. [IL-2] - 5/25/2005

Rep Jackson-Lee, Sheila [TX-18] - 5/19/2005

Rep Jones, Stephanie Tubbs [OH-11] - 11/14/2005

Rep Kilpatrick, Carolyn C. [MI-13] - 5/26/2005

Rep Kucinich, Dennis J. [OH-10] - 2/8/2005

Rep Lantos, Tom [CA-12] - 6/7/2005

Rep Lee, Barbara [CA-9] - 5/5/2005

Rep Lewis, John [GA-5] - 5/25/2005

Rep Lynch, Stephen F. [MA-9] - 11/17/2005

Rep Maloney, Carolyn B. [NY-14] - 5/26/2005

Rep McDermott, Jim [WA-7] - 2/8/2005

Rep McGovern, James P. [MA-3] - 5/10/2005

Rep McKinney, Cynthia A. [GA-4] - 6/16/2005

Rep McNulty, Michael R. [NY-21] - 12/6/2005

Rep Miller, George [CA-7] - 5/10/2005

Rep Nadler, Jerrold [NY-8] - 5/25/2005

Rep Napolitano, Grace F. [CA-38] - 11/14/2005

Rep Olver, John W. [MA-1] - 4/13/2005

Rep Owens, Major R. [NY-11] - 5/10/2005

Rep Pastor, Ed [AZ-4] - 5/18/2005

Rep Payne, Donald M. [NJ-10] - 5/10/2005

Rep Rangel, Charles B. [NY-15] - 4/5/2005

Rep Rush, Bobby L. [IL-1] - 12/15/2005

Rep Sanders, Bernard [VT] - 6/7/2005

Rep Schakowsky, Janice D. [IL-9] - 12/13/2005

Rep Scott, Robert C. [VA-3] - 5/25/2005

Rep Serrano, Jose E. [NY-16] - 5/12/2005

Rep Solis, Hilda L. [CA-32] - 7/12/2005

Rep Stark, Fortney Pete [CA-13] - 5/5/2005

Rep Thompson, Bennie G. [MS-2] - 5/19/2005

Rep Tierney, John F. [MA-6] - 6/15/2005

Rep Towns, Edolphus [NY-10] - 5/26/2005

Rep Udall, Tom [NM-3] - 5/26/2005

Rep Velazquez, Nydia M. [NY-12] - 12/15/2005

Rep Waters, Maxine [CA-35] - 12/15/2005

Rep Watson, Diane E. [CA-33] - 5/5/2005

Rep Waxman, Henry A. [CA-30] - 5/19/2005

Rep Weiner, Anthony D. [NY-9] - 5/25/2005

Rep Woolsey, Lynn C. [CA-6] - 5/10/2005

Rep Wynn, Albert Russell [MD-4] - 5/5/2005

Facts on Uninsured

Under the current Administration healthcare coverage steadily shrinks. In 2000, according to the Census Bureau, 14 percent of Americans didn't have it; in 2003, 15.6 percent--45 million--did not.

As more and more Americans become uninsured, spending on healthcare soars. By 2001 it accounted for 13.9 percent of US gross domestic product.

75 million Americans under age 65 were uninsured over varying periods during 2003-04, up from 81.8 million 2002-03, according to Families USA, the consumer health organization.

Average family premiums in 2005 are projected to be $12,485, up $1,768 from 2004.


Myths on Universal Health Care

By Dr. Marcia Angell, Past Editor New England Journal of Medicine February 4, 2003. Washington D.C.

Myth #1: We can’t afford a national health care system, and if we try it, we will have to ration care. My answer is that we can’t afford not to have a national health care system. A single-payer system would be far more efficient, since it would eliminate excess administrative costs, profits, cost-shifting and unnecessary duplication. Furthermore, it would permit the establishment of an overall budget and the fair and rational distribution of resources. We should remember that we now pay for health care in multiple ways – through our paychecks, the prices of goods and services, taxes at all levels of government, and out-of-pocket. It makes more sense to pay just once.

Myth #2: Innovative technologies would be scarce under a single-payer system, we would have long waiting lists for operations and procedures, and in general, medical care would be threadbare and less available. This misconception is based on the fact that there are indeed waits for elective procedures in some countries with national health systems, such as the U. K. and Canada. But that’s because they spend far less on health care than we do. (The U. K. spends about a third of what we do per person.) If they were to put the same amount of money as we do into their systems, there would be no waits and all their citizens would have immediate access to all the care they need. For them, the problem is not the system; it’s the money. For us, it’s not the money; it’s the system.

Myth #3: A single-payer system amounts to socialized medicine, which would subject doctors and other providers to onerous, bureaucratic regulations. But in fact, although a national program would be publicly funded, providers would not work for the government. That’s currently the case with Medicare, which is publicly funded, but privately delivered. As for onerous regulations, nothing could be more onerous both to patients and providers than the multiple, intrusive regulations imposed on them by the private insurance industry. Indeed, many doctors who once opposed a single-payer system are now coming to see it as a far preferable option.

Myth #4: Claims the government can’t do anything right. Some Americans like to say that, without thinking of all the ways in which government functions very well indeed, and without considering the alternatives. I would not want to see, for example, the NIH, the National Park Service, or the IRS privatized. We should remember that the government is elected by the public and we are responsible for it. An investor-owned insurance company reports to its owners, not to the public.

Articles on National Health Insurance

Trying to Get, and Keep, Care Under Medicaid, The New York Times, New York, NY, October 18, 2005

Wrong Solution for the Uninsured, The New York Times (Opinion), New York, NY, October 17, 2005

Treated for Illness, Then Lost in Labyrinth of Bills, The New York Times, New York, NY, Oct. 13, 2005

National health care would save jobs, The Capital Times, Madison, WI, August 8, 2005

Links to National Health Insurance Organizations: – This is the site for information on the grassroots initiatives in support of National Health Insurance – This is the site of the Physicians for a National Health Program - This site is the official U.S. government website for people with Medicare - Know your rights as a patient

Recent Publications on National Health Care: "Trends and Indicators in the Changing Health Care Marketplace" "Community Voices: Lessons for National Health Policy" "Snapshots of Americas Families Variations in Health Care across States 99-18" "Poor Man's Plight, A: Uncovering the Disparity in Men's Health" "Health Insurance Coverage" "Agency for Healthcare Research and Quality" "Fact Sheet - Addressing Racial and Ethnic Disparities in Health Care" ""Health care is an essential safeguard of human life and dignity and there is an obligation for society to ensure that every person be able to realize this right." "Health spending outpaces economy " "Tax credits urged to help finance health insurance " "Bankruptcy Study Highlights Need For National Health Insurance "

Other Universal Health Care Systems around the World:

1. In a single-payer national health insurance system, such as in Canada, Denmark, Norway, and Sweden, health insurance is publicly administered and most physicians are in private practice. Regional governments, such as the 12 Provinces in Canada, administer the health insurance program for everyone in that region. In single payer insurance systems, government is involved in the financing of health care.

2. Great Britain and Spain are among the Organization for Economic Cooperation and Development (OECD) countries with national health services, in which salaried physicians predominate and hospitals are publicly owned and operated. A national health service is also sometimes called "socialized medicine" because the government in responsible for managing the financing and delivery of health care. Cuba (not in the OECD)

Per Capita Insurance and Underwriting Costs (2000)


Total (in millions)

$ Per Capita


$ 1,092



$ 1,544



$ 2,710



$ 12,293



$ 1,231


United States

$ 57,743



has "socialized medicine" and not only receives very high ratings for providing care on a limited budget (much higher than Jamaica, Haiti, Central America, etc.) but also sends physicians to work in Honduras, El Salvador, and other countries that face physician shortages.

3. A third model of universal health care is a highly regulated, universal, multi-payer health insurance system. This model is in place in countries like Germany, France, and Japan, which have universal health insurance via non-profit "sickness funds" (Germany) or "mutuales" (France). The sickness funds pay physicians and hospitals uniform rates that are negotiated annually (also known as an all-payer system).

Note - Although often suggested as a "more politically feasible" model for the U.S., the non-profit, charitable sickness funds/mutuales are completely different from our for-profit, investor-owned insurance companies. There is no resemblance between an Aetna or Humana and a sickness fund or mutuale. Mutuales do not perform risk rating (i.e. setting rates based on the age, sex, or health status of the person or group) and "cherry-picking," (i.e. excluding people who have pre-existing conditions or are aged, they do not seek to make profits for investors, they are not traded on the stock market, they do not individually contract with doctors and hospitals, and they share funds at the end of the year if one of the funds has lost money. Recent reforms in Germany to make the sickness funds "compete" has mostly resulted in a wave of mergers and higher administrative costs (Germany's system has the highest administrative costs in all of Europe).

International evidence is so strongly in favor of the first model, single payer national health insurance, that the most recent four countries to adopt new programs have adopted single payer. These are Germany and Japan's new long-term care programs (adopted in the 1990's), and acute care programs in Taiwan (1996)and Thailand.

The OECD regularly publishes a CD-ROM with 15+ years of comparative data for those interested in pursuing further research. It is available on the OECD website.

International Labor Unions Who Support HR 676, "The United States National Health Insurance Act"

United Auto Workers

United Electrical, Radio & Machine Workers

United Mineworkers

Petroleum, Atomic & Chemical Workers (PACE)

SEIU, Service Employees International Union

United Steelworkers Of America

Transport Workers Union

International Labor Unions That Have Endorsed Single Payer National Health Insurance

International Association of Machinists and Aerospace Workers

United Electrical, Radio & Machine Workers

Graphics Communications International Union

National Labor Coalitions Who Support "Medicare For All"

Jobs With Justice, Over 155 local unions and social justice organizations across the nation.

Local Labor Unions & National Labor Coalitions Who Support HR 676

1. Duluth (Minnesota) AFL-CIO Central Labor Body

2. American Federation of Government Employees Local 2028, Pittsburgh, PA, representing 1,700 nurses, other professionals & service workers at two Veterans Administration Hospitals

3. Plumbers and Steamfitters HVAC, Local 188, United Association, Savannah, GA.

4. United Steelworkers of America, Local 1693, Louisville, KY, amalgamated local representing 1,700 workers

5. Local 2322, United Automobile Workers, representing 3,800 workers in Holyoke, Massachusetts

6. Washington Alliance of Technology Workers (WashTech), Communications Workers of America (CWA), Local 37083, Seattle, WA

7. Local 576, Laborers’ International Union of North America (LIUNA), Louisville, KY

8. United Association of Plumbers and Pipefitters, Local 630, West Palm Beach, FL

9. Coalition of Labor Union Women (CLUW), National Convention, Oct. 2003

10. Coalition of Black Trade Unionists (CBTU), National Convention, May 2004

11. Jefferson County Teachers’ Association (National Education Association), representing teachers in the public school system, Louisville, KY

12. American Federation of State, County and Municipal Employees (AFSCME) Local 2629, AFL-CIO, representing Louisville Metro Government Employees, Louisville, KY

13. Northwest Indiana Federation of Labor, AFL-CIO

14. Paper, Allied-Industrial, Chemical, Energy International Union (PACE) Local 5-2002, Louisville, KY

15. United Steelworkers of America, Local 6787, representing over 3,000 steelworkers in Burns Harbor, IN

16. Local 506, United Electrical Workers, Erie, PA, representing 4,000 workers at GE.

17. Plumbers, Steamfitters, and Refrigeration Fitters, Local 393, AFL-CIO, San Jose, CA.

18. California State Pipe Trades Council, United Association, AFL-CIO

19. Local 576 Laborers’ International Union Retirees’ Council, LIUNA, AFL-CIO, Louisville, KY

20. Nurses Professional Organization, Louisville, KY

21. Independent State Store Union (ISSU) Harrisburg, PA

22. Local 2320, United Automobile Workers, Chicago, Illinois, representing nearly 4,000 workers across the country, primarily in legal services and human services.

23. Washington Chapter 10, The Retired Public Employees’ Council of Washington, AFSCME, Convention September 2004

24. Steelworkers Active Organization of Retirees (SOAR) Chicago, IL, Chapter 31-9

25. Local 3310, Communications Workers of America (CWA), representing workers at Bell South in Louisville, KY

26. St. Joe Valley Project Jobs with Justice, South Bend, IN

27. United Electrical Workers (UE), Pittsburgh, PA

28. American Guild of Musical Artists (AGMA), Chicago/Midwest Region

29. California Nurses Association

30. National Association of Letter Carriers (NALC), Branch 84, Pittsburgh, PA

31. Local 1375, United Steelworkers in Warren, Ohio

32. National Association of Letter Carriers, Branch 84, Pittsburgh, Pennsylvania

33. Community Action Council, (CAP Council) 3rd & 4th Areas, Kentucky, United Automobile Workers, ( UAW)

34. Community Action Program, (CAP Council) Southern Indiana, United Automobile Workers, (UAW)

35. South Bay, AFL-CIO Labor Council, California

36. USWA 6787, United Steelworkers of America, Burns Harbor, Indiana, represents over 3,000 workers at the Burns Harbor, Ind, plant of (International Steel Group,)

37. Northwest Indiana Federation of Labor of the AFL-CIO, 40 members.

38. Communications Workers of America Local 6355, Missouri State Workers' Union, of St. Louis, MO

For further information: Kay Tillow, Nurses Professional Organization, 1169 Eastern Parkway, #2218, Louisville, KY 40217, (502) 459-3393,