HR 676 / Weiner Amendment: What It Would Do

HR 676 is John Conyer's bill to establish single-payer national health insurance in the U.S. It is also called the "United States National Health Care Act" and the "Expanded and Improved Medicare for All Act". The bill has about 85 co-sponsors in the House of Representatives.

Anthony Weiner has offered an amendment, which will be voted on in the floor of the house this month, which would effectively change the thousand-page HR 3200 bill currently being worked on by Congress into the thirty-page bill, HR 676. I encourage everyone to contact their representatives in Congress in support of this amendment. In future posts I hope to enumerate why HR 3200, even with what is being called a "robust" public option, would do nothing to address the biggest problems of our healthcare system: high costs, rising costs, lack of access to care, and large disparities in care. Such "incremental" reforms have been tried before, such as in Massachusetts, Oregon, and Tennessee (and Massachusetts again), and each time have failed to deliver on the goals President Obama hopes to fulfill.

Here is a summary of the important things that HR 676 (aka the Weiner Amendment to HR 3200) would do, with references to page numbers where statements are made within the bill, available here: kucinich.house.gov/UploadedFiles/HR_676_111th.pdf

Eligibility:

• Every resident of America would automatically have government-administered health insurance from birth until death. (Page 4)

Benefits and Portability:

• This health insurance would cover primary care and preventative care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long-term care, palliative care, mental health services, dental services (other than cosmetic dentistry), substance abuse treatment services, chiropractic services, basic vision and vision correction (other than laser vision correction for cosmetic purposes), hearing services, including coverage of hearing aids, and podiatric care. (Page 5)
• Patients would have full choice of physician. (Page 6, also Page 9)
  
• This health insurance would be paid for through taxes, with no separate premiums, co-pays, or deductibles (no cost-sharing).(Page 6)
  

Qualification of Providers:

• Providers could remain private or public, but will be required to be non-profit (not investor-owned). Health provider institutions (hospitals, clinics, etc.) that are curently investor-owned must convert to non-profit status. However, the government does not "take over" providers - they remain private. (Page 6)
• Owners of for-profit institutions will receive reasonable compensation for losses associated with the transition to non-profit status. (Page 7)
  
• This compensation will be funded during a 15-year period through the sale of Treasury bonds. (Page 7)
• Non-profit HMOs that deliver care in their own facilities and maintain salaried physicians can continue to practice as such, receiving funding from the National Health Program. Other HMOs, which principally contract to pay for services delivered by non-employees, are considered insurance plans, which will be discussed below (Page 8).

Prohibition against duplication coverage

• It will be illegal for a private health insurer to offer coverage for any services already covered by Medicare, but legal to offer coverage for anything else. (Page 9)

Budgeting Process

• Every year shall be established a national budget for (1) operating expenses, (2) capital expenditures (3) reimbursement levels, and (4) health professions education. The Director will then distribute this budget to regional directors. (page 10)
• Money intended for capital expenditures cannot be used for operating costs and vice versa. (Page 11) (This is an important provision that prevents hospitals from skimping on care in order to beef up their collection of machines and wings).

Payment of Providers and Health Care Clinicians

• Regional directors of the national health program will pay institutions monthly lump sums, which the institutions then distribute as necessary. The amounts will be negotiated between institutional directors and health program directors. (Pages 11-12).
• Physicians and certain other health professionals can choose between being paid on a traditional fee for service model, taking a salaried position in an institution receiving a global budget, or taking a salaried position within a group practice receiving capitation payments.
• Current going rates (not the lower, Medicare rates) shall be the basis upon which the fee schedule will be based (Pages 12-13).
• Providers cannot charge extra to patients for covered services (Page 14).
• Payment shall utilize a uniform national electronic billing system.
• Full coverage for long-term care such as in-home, nursing home, and community based care will be included. All efforts will be made to favor non-institutional care in a home or community-based setting (Pages 16-17).
  
• Full coverage for mental health care, such as supportive residences, occupational therapy, and ongoing mental health and counseling services will be included (Page 17).

Funding: (Pages 19 and 20)

• The National Health Care Program will be funded via a Trust Fund to be paid for with:
• Existing sources of Federal Government Revenues for Healthcare (Medicare, Medicaid, IHS, etc.)
• Increasing personal income tax on the top 5% of earners.
• Instituting a "modest and progressive excise tax on payroll and self-employment income".
• Instituting a small tax on stock and bond transfers.
• Vast reductions of paperwork and rational bulk procurement of medications resulting in savings totaling $387 billion.

Administration:

• This part of the bill (Pages 21-28) is a bit boring and covers how the administrative system (Director of Health and Human Services, Regional Directors, Office of Quality Control, National Board of Universal Quality and Access, etc.) would be organized.
• Every worker whose job is eliminated due to simplification of administration will have first priority in retraining and job placement in the new system. Laid-off workers will also be eligible for two years of unemployment benefits with benefits in each year equal to the salary earned during the last 12 months of employment, but not exceeding $100,000 a year. These benefits are in addition to any other state and federal unemployment benefits that may apply. (Page 24)
  

Additional Provisions

• The VA program will remain independent for 10 years, and the IHS for 5 years, at which point their independence will be reevaluated by Congress. (Page 29)
  
• Sound public health will be stressed at all times by the Program. (Page 29)
• It is the intent of the 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.

Effective Date

• The act will take effect on the first date of the first year that begins more than one year after the enactment of the act. For example, passage in 2009 would mean a start date of 1/1/2011.