Conyers Explanation Expanded Medicare for All HR 676
Downloaded from http://www.house.gov/conyers; condensed by Bob Alexander,
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.
· 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
Articles on National Health Insurance
Trying to Get, and Keep, Care Under Medicaid,
The New York Times, New York, NY, October
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.
National health care would save jobs,
The Capital Times, Madison, WI, August 8, 2005
Links to National Health Insurance Organizations:
www.cnhpnow.org – This is the site for information on the grassroots initiatives
in support of National Health Insurance
www.pnhp.org – This is the site of the Physicians for a National Health Program
http://www.medicare.gov/ - This site is the official U.S. government website for
people with Medicare
http://www.cms.hhs.gov/hipaa/ - Know your rights as a patient
Recent Publications on National Health Care:
http://www.kff.org/insurance/index.cfm: "Trends and Indicators in the Changing Health
Voices: Lessons for National Health Policy"
of Americas Families Variations in Health Care across States 99-18"
"Poor Man's Plight, A: Uncovering the Disparity in Men's Health"
http://www.cdc.gov/nchs/fastats/hinsure.htm: "Health Insurance Coverage"
http://www.ahrq.gov/: "Agency for Healthcare Research and Quality"
http://www.ahrq.gov/research/disparit.htm: "Fact Sheet - Addressing Racial and Ethnic
Disparities in Health Care"
http://www.pnhp.org/: ""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."
http://www.ama-assn.org/amednews/2005/03/14/gvsa0314.htm: "Health spending outpaces
http://www.kansascity.com/mld/kansascity/business/11046120.htm: "Tax credits urged
to help finance health insurance "
http://www.pnhp.org/news/2005/february/bankruptcy_study_hig.php: "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.
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
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.
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).
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).
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.
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
United Auto Workers
United Electrical, Radio & Machine Workers
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
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,
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,
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,
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
17. Plumbers, Steamfitters, and Refrigeration Fitters, Local 393, AFL-CIO, San Jose,
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,
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, firstname.lastname@example.org