Medicare for All

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Medicare for All
Medicare for All.
Everybody In. Nobody Out.

H.R. 676 plus Q&A and Explanations

Improved Medicare for All, universal health care,
as per the
Expanded and Improved Medicare for All Act

United States House of Representatives Bill Number 676 is the proposed U.S. legislation to establish improved Medicare for All, universal health care, in the United States. It will establish lifelong health care: "cradle to grave", "womb to tomb". The coverage will be complete; some people like to call that “comprehensive.”

Every other free-market country ** in the world automatically provides health care for its people with a largely or exclusively non-profit method of financing the health care. Even the two free-market countries that are considered to be "low income", Mexico and Turkey, have been implementing universal health care.

The best non-profit method has 1 fund and 1 plan and 1 payer (“single-payer”) because it is the simplest and most efficient. The specific funding details need to be established, such as the method(s) proposed in H.R. 676.

What matters is not so much how we pay for it, since the costs will be dramatically lower, but what we will pay for:
— We will no longer be paying for a system that wastes $400 billion in excessive administrative costs.
— Much more of our health care dollars will be spent on health care.
— More of the doctors and nurses time will be spent on caring for people.
— The result will be more time spent on prevention and wellness and the U.S. dramatically raising its life expectancy, which is 31st according to the World Health Organization and 42nd according to the CIA Factbook, which monitors all the countries of the world.

H.R. 676 Questions and Answers

What medical care coverage is provided? - See the list of benefits listed in the resolution.

How much will it cost (or save) me and my family? Funding of the national health insurance is described in Section-211. Most Americans will experience a dramatic savings of money from the fact that the increase in taxes will be small compared to the elimination of payments to for-profit health insurance companies.

Will I need to pay deductibles and co-pays? - We may need to pay a small co-pay, but not according to this current version of H.R. 676. The result will be up to the debating and final resolution of details for the law. However, House Resolution 676 is based on zero “cost-sharing” (such as no deductibles and no copayments), as noted and discussed here in Section 102 (c).

What choices will I have? - The BEST choices! Not only will you have full choice of what physician and what medical facilities, but also better choices that are life decisions! See a list here.

How will my primary care physician get paid? - Primary care physicians who currently have a private practice will maintain their private practice. They will be paid a standard “fee for service” each time they perform a particular service. That will be like what happens today, but your physician will get paid automatically within 30 days from one payer, the “single-payer” instead of dealing with dozens or hundreds of for-profit health insurance companies. Your physician will spend dramatically less time on administrative paperwork and will be able to focus more time and attention on you and other patients. See below

What private health insurance will I be able to purchase? For-profit health insurance companies will be able to sell health insurance to provide medical coverage for benefits not covered by H.R. 676. Examples would be cosmetic surgery that is personal choice (elective), not other reasons, such as an accident, disease or act of war. See the resolution’s text here.

Will for-profit health insurance companies convert to non-profit? No. This law establishes one publicly-owned non-profit health insurance program that automatically covers everyone by the operation of one public agency. Having all U.S. residents in one group (sometimes called a “risk pool”) achieves the largest degree of benefit for everyone at the lowest possible cost.

Where will the employees of those companies be employed when their company stops its operations? Some will work in the new organization. They will have top priority consideration for the new positions. Others will move back to their original profession of health care or be able to spend most or all of their day on health care instead of paperwork. Employees who do not immediately find positions will be eligible for up to two years of unemployment compensation to help them make the transition to a new job or new profession.

What organization will provide the management of this publicly-owned health insurance program? The structure of the organization will be based on the same ten regional offices that are already in place for the original Medicare program, which is being replaced with an Expanded and Improved Medicare for All.

H.R. 676 Text with [Explanations] in brackets

 ... scroll down to the TOC or select here: H.R. 676 Table of Contents

The complete text of the H.R. 676 resolution, as below, was copied to here to provide explanations and better formatting. Small changes were made to improve the readability; hyper-links were added.
Information in brackets [ ] provides explanations.

HR 676 IH as per January 24, 2017 in the 115th Congress (effective 2017 through 2018)

[“IH” means introduced in the U.S. House; a resolution is generally understood to need at least 100 co-sponsors to be debated, but having 100 co-sponsors does not necessarily mean that a resolution will definitely be debated on the floor of the U.S. House.]

[This bill was originally introduced in 2003.]


H. R. 676

Expanded and Improved Medicare for All Act (Introduced in House)

To provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes.


January 24, 2017

[The following list of U.S. Representatives consists only of those who signed up first to be co-sponsors in January 2017. To see whether or not a specific representative now co-sponsors H.R. 676, go the list of supporters.]

Mr. Conyers (for himself, Mr. Huffman, Ms. Lee, Ms. Clark of Massachusetts, Mr. Clay, Mr. Clyburn, Mr. Cohen, Mr. Cummings, Mr. Ellison, Mr. Engel, Mr. Grijalva, Ms. Jackson Lee, Mr. Ted Lieu of California, Ms. Norton, Mr. Pocan, Ms. Roybal-Allard, Mr. Ryan of Ohio, Mr. Scott of Virginia, Mr. Serrano, Mr. Takano, Ms. Kaptur, Mr. Jeffries, Mr. Lewis of Georgia, Mr. Tonko, Mr. Thompson of Mississippi, Ms. Schakowsky, Mrs. Watson Coleman, Mr. Welch, Mrs. Napolitano, Mr. Brady of Pennsylvania, Mr. Cartwright, Ms. Pingree, Mrs. Lawrence, Mr. Garamendi, Ms. Lofgren, Mr. Blumenauer, Ms. Kelly of Illinois, Ms. Clarke of New York, Mr. Nolan, Mr. Cleaver, Mr. Hastings, Ms. Judy Chu of California, Mr. McGovern, Mr. Johnson of Georgia, Mr. Nadler, Ms. Jayapal, Mr. Michael F. Doyle of Pennsylvania, Ms. Adams, Mrs. Beatty, Mr. Al Green of Texas, Mr. DeSaulnier, and Ms. Moore) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.



To provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

H.R. 676 Table of Contents

  • (a) Short Title - This Act may be cited as the
    • Expanded and Improved Medicare for All Act.
  • (b) Table of Contents  The table of contents of this Act is as follows:

    • Sec. 1. Short title; table of contents.
    • Sec. 2. Definitions and terms.

    • Sec. 101. Eligibility and registration.
    • Sec. 102. Benefits and portability.
    • Sec. 103. Qualification of participating providers.
    • Sec. 104. Prohibition against duplicating coverage.
  • Subtitle A–Budgeting and Payments
    • Sec. 201. Budgeting process.
    • Sec. 202. Payment of providers and health care clinicians.
    • Sec. 203. Payment for long-term care.
    • Sec. 204. Mental health services.
    • Sec. 205. Payment for prescription medications, medical supplies, and medically necessary assistive equipment.
    • Sec. 206. Consultation in establishing reimbursement levels.
  • Subtitle B–Funding
    • Sec. 211. Overview: funding the Medicare for All Program.
    • Sec. 212. Appropriations for existing programs.
    • Sec. 301. Public administration; appointment of Director.
    • Sec. 302. Office of Quality Control.
    • Sec. 303. Regional and State administration; employment of displaced clerical workers.
    • Sec. 304. Confidential Electronic Patient Record System.
    • Sec. 305. National Board of Universal Quality and Access.
    • Sec. 401. Treatment of VA and IHS health programs.
    • Sec. 402. Public health and prevention.
    • Sec. 403. Reduction in health disparities.


In this Act:

  • (1) MEDICARE FOR ALL PROGRAM; PROGRAM- The terms “Medicare for All Program” and “Program” mean the program of benefits provided under this Act and, unless the context otherwise requires, the Secretary with respect to functions relating to carrying out such program.
    • [This is a change in the proposed name of the program compared to H.R. 676 as proposed in the previous sessions of Congress. It’s part of an increased use of the words “Medicare for All” within the Medicare for All movement.]
  • (2) NATIONAL BOARD OF UNIVERSAL QUALITY AND ACCESS- The term “National Board of Universal Quality and Access” means such Board established under section 305.
  • (3) REGIONAL OFFICE- The term “regional office” means a regional office established under section 303.
  • (4) SECRETARY- The term “Secretary” means the Secretary of Health and Human Services.
  • (5) DIRECTOR- The term “Director” means, in relation to the Program, the Director appointed under section 301.



  • (a) In General- All individuals residing in the United States (including any territory of the United States) are covered under the Medicare for All Program entitling them to a universal, best quality standard of care. Each such individual shall receive a card with a unique number in the mail. An individual’s social security number shall not be used for purposes of registration under this section.
    • [Note that details need to be decided when the resolution is debated in the U.S. House, such as how many weeks or months a person may need to have been a resident in the United States.]
  • (b) Registration- Individuals and families shall receive a Medicare for All Program Card in the mail, after filling out a Medicare for All Program application form at a health care provider. Such application form shall be no more than 2 pages long.
  • (c) Presumption- Individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this Act, but shall complete an application for benefits in order to receive a Medicare for All Program Card and have payment made for such benefits.
  • (d) Residency Criteria- The Secretary shall promulgate a rule that provides criteria for determining residency for eligibility purposes under the Medicare for All Program.
  • (e) Coverage for Visitors- The Secretary shall promulgate a rule regarding visitors from other countries who seek premeditated non-emergency surgical procedures. Such a rule should facilitate the establishment of country-to-country reimbursement arrangements or self pay arrangements between the visitor and the provider of care.


  • (a) In General- The health care benefits under this Act cover all medically necessary services, including at least the following:
  • [ The following list represents all medically-necessary care from pre-natal through the end of life.]
    • (1) Primary care and prevention.
    • (2) Approved dietary and nutritional therapies.
      • [This is an addition to the proposed health care benefits compared to H.R. 676 as proposed in the previous session of Congress.]
    • (3) Inpatient care. [such as in hospitals]
    • (4) Outpatient care. [such as in hospital outpatient areas medical facilities not associated with a hospital, such a physical therapy center]
    • (5) Emergency care.
    • (6) Prescription drugs.
    • (7) Durable medical equipment.
    • (8) Long term care.
    • (9) Palliative care.
    • (10) Mental health services.
    • (11) The full scope of dental services, services, including periodontics, oral surgery and endodontics, but not including cosmetic dentistry.
      [The second “services” is apparently a mistake in the bill.]
      • [The words “periodontics, oral surgery, and endodontics” were added (to clarify that these benefits are included as part of dental services) compared to H.R. 676 as proposed in the previous session of Congress.]
    • (12) Substance abuse treatment services.
    • (13) Chiropractic services, not including electrical stimulation.
    • (14) Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
    • (15) Hearing services, including coverage of hearing aids.
    • (16) Podiatric care.
    • [Action note: Coverage of additional services will be determined during debate in the U.S. House and U.S. Senate. Examples: holistic medicine, herbal medicine and specifics of other topics about which you are concerned. When you communicate, such as via your monthly letter to your U.S. Representative, keep in mind how you can NOW immediately start contributing to the debate that we need: HOW to implement non-profit financing of health care. As an example, if you want holistic medicine to be considered, communicate that with your monthly letters to your U.S. Representative.]
  • (b) Portability - Such benefits are available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits.
    • [LIFE CHOICES …]
    • [No matter what significant decisions you make about your life, you will always have health insurance, such as the following examples of life decisions:]
      • [Choose your profession more freely.]
      • [Choose your employer more freely.]
      • [Work part-time or take an extended leave from work to be able to contribute to the care of a loved one.]
      • [Get married or stay single.]
      • [Decide when you want to retire.]


[No Cost-Sharing, as defined in Section 102; this means no major medical bills]

  • (c) No Cost-Sharing - No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.
    • [In other words, due to the high efficiency of Improved Medicare for All, the funding is enough to cover all medically-necessary services. Experience in the subject of cost-sharing in the U.S. and other countries has confirmed that it is detrimental rather than beneficial to a country’s health care utilization.]


  • [Note that this section is only about health care providers, not health insurance companies.]
  • (a) Requirement To Be Public or Non-Profit-
    • (1) IN GENERAL - No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned.
    • (2) CONVERSION OF INVESTOR-OWNED PROVIDERS - For-profit providers of care opting to participate shall be required to convert to not-for-profit status.
    • (3) PRIVATE DELIVERY OF CARE REQUIREMENT- For-profit providers of care that convert to non-profit status shall remain privately owned and operated entities.
    • (4) COMPENSATION FOR CONVERSION - The owners of such for-profit providers shall be compensated for reasonable financial losses incurred as a result of the conversion from for-profit to non-profit status.
    • (5) FUNDING - There are authorized to be appropriated from the Treasury such sums as are necessary to compensate investor-owned providers as provided for under paragraph (3).
    • (6) REQUIREMENTS - The payments to owners of converting for-profit providers shall occur during a 15-year period, through the sale of U.S. Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits.
    • (7) MECHANISM FOR CONVERSION PROCESS- The Secretary shall promulgate a rule to provide a mechanism to further the timely, efficient, and feasible conversion of for-profit providers of care.
  • (b) Quality Standards-
    • (1) IN GENERAL - Health care delivery facilities must meet State quality and licensing guidelines as a condition of participation under such program, including guidelines regarding safe staffing and quality of care.
    • (2) LICENSURE REQUIREMENTS - Participating clinicians must be licensed in their State of practice and meet the quality standards for their area of care. No clinician whose license is under suspension or who is under disciplinary action in any State may be a participating provider.
  • (c) Participation of Health Maintenance Organizations -
    • (1) IN GENERAL - Non-profit health maintenance organizations that deliver care in their own facilities and employ clinicians on a salaried basis may participate in the program and receive global budgets or capitation payments as specified in section 202. [Capitation payments are payments based on an agreement to provide health care for a specific amount of money for a specific time period, such as a quarter or a year.]
    • (2) EXCLUSION OF CERTAIN HEALTH MAINTENANCE ORGANIZATIONS - Other health maintenance organizations which principally contract to pay for services delivered by non-employees, shall be classified as insurance plans. Such organizations shall not be participating providers, and are subject to the regulations promulgated by reason of section 104(a) (relating to prohibition against duplicating coverage).
    • [Any remaining HMO’s will be non-profit providers of health care.]
  • (d) Freedom of Choice - Patients shall have free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities. [Before the implementation of national health insurance millions of Americans have no freedom to choose. The are restricted to certain medical professionals and facilities by the insurance health plan that they have.]


  • (a) In General- It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.
  • (b) Construction- Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, such as for cosmetic surgery or other services and items that are not medically necessary.
  • [For-profit health insurance companies can still sell health insurance, but only for services that are not covered by the national plan.]


Subtitle A–Budgeting and Payments


  • (a) Establishment of Operating Budget and Capital Expenditures Budget-
    • (1) IN GENERAL- To carry out this Act there are established on an annual basis consistent with this title–
      • (A) an operating budget, including amounts for optimal physician, nurse, and other health care professional staffing;
      • (B) a capital expenditures budget;
      • (C) reimbursement levels for providers consistent with subtitle B; and
      • (D) a health professional education budget, including amounts for the continued funding of resident physician training programs.
    • (2) REGIONAL ALLOCATION- After Congress appropriates amounts for the annual budget for the Medicare for All Program, the Director shall provide the regional offices with an annual funding allotment to cover the costs of each region’s expenditures. Such allotment shall cover global budgets, reimbursements to clinicians, health professional education and capital expenditures. Regional offices may receive additional funds from the national program at the discretion of the Director.
  • (b) Operating Budget- The operating budget shall be used for–
    • (1) payment for services rendered by physicians and other clinicians;
    • (2) global budgets for institutional providers;
    • (3) capitation payments for capitated groups;
      • [Capitation payments are payments based on an agreement to provide health care for a specific amount of money for a specific time period, such as a quarter or a year.]
    • (4) administration of the Program.
  • (c) Capital Expenditures Budget- The capital expenditures budget shall be used for funds needed for–
    • (1) the construction or renovation of health facilities; and
    • (2) for major equipment purchases.
  • (d) Prohibition Against Co-Mingling Operations and Capital Improvement Funds- It is prohibited to use funds under this Act that are earmarked–
    • (1) for operations for capital expenditures; or
    • (2) for capital expenditures for operations.


  • (a) Establishing Global Budgets; Monthly Lump Sum-
    • (1) IN GENERAL- The Medicare for All Program, through its regional offices, shall pay each institutional provider of care, including hospitals, nursing homes, community or migrant health centers, home care agencies, or other institutional providers or pre-paid group practices, a monthly lump sum to cover all operating expenses under a global budget.
    • (2) ESTABLISHMENT OF GLOBAL BUDGETS- The global budget of a provider shall be set through negotiations between providers, State directors, and regional directors, but are subject to the approval of the Director. The budget shall be negotiated annually, based on past expenditures, projected changes in levels of services, wages and input, costs, a provider’s maximum capacity to provide care, and proposed new and innovative programs.
  • (b) Three Payment Options for Physicians and Certain Other Health Professionals-
    • (1) IN GENERAL- The Program shall pay physicians, dentists, doctors of osteopathy, pharmacists, psychologists, chiropractors, doctors of optometry, nurse practitioners, nurse midwives, physicians’ assistants, and other advanced practice clinicians as licensed and regulated by the States by the following payment methods:
      • (A) Fee for service payment under paragraph (2).
      • (B) Salaried positions in institutions receiving global budgets under paragraph (3).
      • (C) Salaried positions within group practices or non-profit health maintenance organizations receiving capitation payments under paragraph (4).
    • (2) FEE FOR SERVICE-
      • (A) IN GENERAL- The Program shall negotiate a simplified fee schedule that is fair and optimal with representatives of physicians and other clinicians, after close consultation with the National Board of Universal Quality and Access and regional and State directors. Initially, the current prevailing fees or reimbursement would be the basis for the fee negotiation for all professional services covered under this Act. [This establishment of fees is not much different than what we have already. That is, it is similar to what the for-profit health insurance companies have established now as “reasonable and customary fees”.]
      • (B) CONSIDERATIONS- In establishing such schedule, the Director shall take into consideration the following:
        • (i) The need for a uniform national standard.
        • (ii) The goal of ensuring that physicians, clinicians, pharmacists, and other medical professionals be compensated at a rate which reflects their expertise and the value of their services, regardless of geographic region and past fee schedules. [Clarification: logical differences in dramatically different cost-of-living and cost-of-business will be addressed with input from the regions about those differences]
      • (C) STATE PHYSICIAN PRACTICE REVIEW BOARDS- The State director for each State, in consultation with representatives of the physician community of that State, shall establish and appoint a physician practice review board to assure quality, cost effectiveness, and fair reimbursements for physician delivered services.
      • (D) FINAL GUIDELINES- The regional directors shall be responsible for promulgating final guidelines to all providers.
      • (E) BILLING- Under this Act physicians shall submit bills to the regional director on a simple form, or via computer. Interest shall be paid to providers whose bills are not paid within 30 days of submission. [Billing will be done from your physician’s office to your region of the “single-payer”, public agency, which will pay your physician. You will not be sent a bill.]
      • (F) NO BALANCE BILLING- Licensed health care clinicians who accept any payment from the Medicare for All Program may not bill any patient for any covered service. [ This is further emphasis that you will not be sent a bill, unless the service is not a covered service by the national health insurance.]
      • (G) UNIFORM COMPUTER ELECTRONIC BILLING SYSTEM- The Director shall create a uniform computerized electronic billing system, including those areas of the United States where electronic billing is not yet established.
      • (A) IN GENERAL- In the case of an institution, such as a hospital, health center, group practice, community and migrant health center, or a home care agency that elects to be paid a monthly global budget for the delivery of health care as well as for education and prevention programs, physicians and other clinicians employed by such institutions shall be reimbursed through a salary included as part of such a budget.
      • (B) SALARY RANGES- Salary ranges for health care providers shall be determined in the same way as fee schedules under paragraph (2).
      • [Capitation payments are payments based on an agreement to provide health care for a specific amount of money for a specific time period, such as a quarter or a year.]
      • (A) IN GENERAL- Health maintenance organizations, group practices, and other institutions may elect to be paid capitation premiums to cover all outpatient, physician, and medical home care provided to individuals enrolled to receive benefits through the organization or entity.
      • (B) SCOPE- Such capitation may include the costs of services of licensed physicians and other licensed, independent practitioners provided to inpatients. Other costs of inpatient and institutional care shall be excluded from capitation payments, and shall be covered under institutions’ global budgets.
      • (C) PROHIBITION OF SELECTIVE ENROLLMENT- Patients shall be permitted to enroll or disenroll from such organizations or entities without discrimination and with appropriate notice.
        • (i) health maintenance organizations shall be required to reimburse physicians based on a salary; and
        • (ii) financial incentives between such organizations and physicians based on utilization are prohibited.


  • (a) Allotment for Regions- The Program shall provide for each region a single budgetary allotment to cover a full array of long-term care services under this Act.
  • (b) Regional Budgets- Each region shall provide a global budget to local long-term care providers for the full range of needed services, including in-home, nursing home, and community based care.
    • (c) Basis for Budgets - Budgets for long-term care services under this section shall be based on past expenditures, financial and clinical performance, utilization, and projected changes in service, wages, and other related factors.
  • (d) Favoring Non-Institutional Care - All efforts shall be made under this Act to provide long-term care in a home- or community-based setting, as opposed to institutional care.


  • [Having mental health services be automatically covered solves a significant issue(s) in the United States related to mental health.]
  • (a) In General- The Program shall provide coverage for all medically necessary mental health care on the same basis as the coverage for other conditions. Licensed mental health clinicians shall be paid in the same manner as specified for other health professionals, as provided for in section 202(b).
  • (b) Favoring Community-Based Care- The Medicare for All Program shall cover supportive residences, occupational therapy, and ongoing mental health and counseling services outside the hospital for patients with serious mental illness. In all cases the highest quality and most effective care shall be delivered, and, for some individuals, this may mean institutional care.


  • (a) Negotiated Prices - The prices to be paid each year under this Act for covered pharmaceuticals, medical supplies, and medically necessary assistive equipment shall be negotiated annually by the Program. [People in other countries pay far less than Americans for drugs prior to the implementation of the U.S. National Health Insurance.]
  • (b) Prescription Drug Formulary -
    • (1) IN GENERAL- The Program shall establish a prescription drug formulary system, which shall encourage best-practices in prescribing and discourage the use of ineffective, dangerous, or excessively costly medications when better alternatives are available.
    • (2) PROMOTION OF USE OF GENERICS- The formulary shall promote the use of generic medications but allow the use of brand-name and off-formulary medications.
    • (3) FORMULARY UPDATES AND PETITION RIGHTS- The formulary shall be updated frequently and clinicians and patients may petition their region or the Director to add new pharmaceuticals or to remove ineffective or dangerous medications from the formulary.


  • Reimbursement levels under this subtitle shall be set after close consultation with regional and State Directors and after the annual meeting of National Board of Universal Quality and Access.

Subtitle B–Funding


  • (a) In General- The Medicare for All Program is to be funded as provided in subsection (c)(1).
  • (b) Medicare for All Trust Fund- There shall be established a Medicare for All Trust Fund in which funds provided under this section are deposited and from which expenditures under this Act are made.

  • (c) Funding-
    • (1) IN GENERAL- There are appropriated to the Medicare for All Trust Fund amounts sufficient to carry out this Act from the following sources:
    • [NOTE: the following part of H.R. 676 describes only one idea for the funding. After sufficient support is established in the U.S. House of Representatives, many funding options will likely be debated. It will be important for some citizens to monitor the progress and give input at that time. In the meantime, any ideas or wishes you have for funding should be sent by letter in the U.S. Mail to your U.S. Representative and U.S. Senators.]
      • (A) Existing sources of Federal government revenues for health care.
      • (B) Increasing personal income taxes on the top 5 percent income earners.
        • (to do: need to communicate what level of income this means)
      • (C) Instituting a modest and progressive excise tax on payroll and self-employment income.
        • [Current Medicare tax: 1.45% paid by employers and employees.]
      • (D) Instituting a modest tax on unearned income.
        • [This is an additional source of funding … added to the H.R. 676 that was proposed in the previous session of Congress. The expected percentage is not yet available. H.R. 676 will not be given an economic evaluation by the Congressional Budget Office until it gets to at least 100 cosponsors<.]
      • (E) Instituting a small tax on stock and bond transactions.
    • (2) SYSTEM SAVINGS AS A SOURCE OF FINANCING- Funding otherwise required for the Program is reduced as a result of–
      • (A) vastly reducing paperwork
      • (B) requiring a rational bulk procurement of medications under section 205(a).
      • (C) improved access to preventive health care.
    • (3) ADDITIONAL ANNUAL APPROPRIATIONS TO MEDICARE FOR ALL PROGRAM- Additional sums are authorized to be appropriated annually as needed to maintain maximum quality, efficiency, and access under the Program.


  • Notwithstanding any other provision of law, there are hereby transferred and appropriated to carry out this Act, amounts from the Treasury equivalent to the amounts the Secretary estimates would have been appropriated and expended for Federal public health care programs, including funds that would have been appropriated under the Medicare program under title XVIII of the Social Security Act, under the Medicaid program under title XIX of such Act, and under the Children’s Health Insurance Program under title XXI of such Act. »[The cost for most Americans will be primarily or only the tax on payroll (employee and employer) or self-employment income. The savings from not having to pay for-profit health insurance premiums will be dramatically more than the increased payroll cost, as seen at the Costs and Savings web page.]



  • (a) In General- Except as otherwise specifically provided, this Act shall be administered by the Secretary through a Director appointed by the Secretary.
  • (b) Long-Term Care- The Director shall appoint a director for long-term care who shall be responsible for administration of this Act and ensuring the availability and accessibility of high quality long-term care services.
  • (c) Mental Health- The Director shall appoint a director for mental health who shall be responsible for administration of this Act and ensuring the availability and accessibility of high quality mental health services.


  • The Director shall appoint a director for an Office of Quality Control. Such director shall, after consultation with state and regional directors, provide annual recommendations to Congress, the President, the Secretary, and other Program officials on how to ensure the highest quality health care service delivery. The director of the Office of Quality Control shall conduct an annual review on the adequacy of medically necessary services, and shall make recommendations of any proposed changes to the Congress, the President, the Secretary, and other Medicare for All program officials.


  • (a) Establishment of Medicare for All Program Regional Offices- The Secretary shall establish and maintain Medicare for All regional offices for the purpose of distributing funds to providers of care. Whenever possible, the Secretary should incorporate pre-existing Medicare infrastructure for this purpose. [The pre-existing regions are shown here.]
  • (b) Appointment of Regional and State Directors- In each such regional office there shall be–
    • (1) one regional director appointed by the Director; and
    • (2) for each State in the region, a deputy director (in this Act referred to as a `State Director’) appointed by the governor of that State.
  • (c) Regional Office Duties- Regional offices of the Program shall be responsible for–
    • (1) coordinating funding to health care providers and physicians; and
    • (2) coordinating billing and reimbursements with physicians and health care providers through a State-based reimbursement system.
  • (d) State Director’s Duties- Each State Director shall be responsible for the following duties:
    • (1) Providing an annual state health care needs assessment report to the National Board of Universal Quality and Access, and the regional board, after a thorough examination of health needs, in consultation with public health officials, clinicians, patients, and patient advocates.
    • (2) Health planning, including oversight of the placement of new hospitals, clinics, and other health care delivery facilities.
    • (3) Health planning, including oversight of the purchase and placement of new health equipment to ensure timely access to care and to avoid duplication.
    • (4) Submitting global budgets to the regional director.
    • (5) Recommending changes in provider reimbursement or payment for delivery of health services in the State.
    • (6) Establishing a quality assurance mechanism in the State in order to minimize both under utilization and over utilization and to assure that all providers meet high quality standards.
    • (7) Reviewing program disbursements on a quarterly basis and recommending needed adjustments in fee schedules needed to achieve budgetary targets and assure adequate access to needed care.

[Following is proposed legislation within H.R. 676 Section 303 for providing support for retraining, job placement and employment transition.]

  • (e) First Priority in Retraining and Job Placement; 2 Years of Salary Parity Benefits- The Program shall provide that clerical, administrative, and billing personnel in insurance companies, doctors offices, hospitals, nursing facilities, and other facilities whose jobs are eliminated due to reduced administration–
    • (1) should have first priority in retraining and job placement in the new system; and
    • (2) shall be eligible to receive two years of Medicare for All employment transition benefits with each year’s benefit equal to salary earned during the last 12 months of employment, but shall not exceed $100,000 per year.
  • (f) Establishment of Medicare for All Employment Transition Fund- The Secretary shall establish a trust fund from which expenditures shall be made to recipients of the benefits allocated in subsection (e).
  • (g) Annual Appropriations to Medicare for All Employment Transition Fund- Sums are authorized to be appropriated annually as needed to fund the Medicare for All Employment Transition Benefits.
  • (h) Retention of Right to Unemployment Benefits- Nothing in this section shall be interpreted as a waiver of Medicare for All Employment Transition benefit recipients’ right to receive Federal and State unemployment benefits.


  • (a) In General- The Secretary shall create a standardized, confidential electronic patient record system in accordance with laws and regulations to maintain accurate patient records and to simplify the billing process, thereby reducing medical errors and bureaucracy.
  • (b) Patient Option- Notwithstanding that all billing shall be preformed electronically, patients shall have the option of keeping any portion of their medical records separate from their electronic medical record.


  • (a) Establishment-
    • (1) IN GENERAL- There is established a National Board of Universal Quality and Access (in this section referred to as the “Board”) consisting of 15 members appointed by the President, by and with the advice and consent of the Senate.
    • (2) QUALIFICATIONS- The appointed members of the Board shall include at least one of each of the following:
      • (A) Health care professionals.
      • (B) Representatives of institutional providers of health care.
      • (C) Representatives of health care advocacy groups.
      • (D) Representatives of labor unions.
      • (E) Citizen patient advocates.
    • (3) TERMS- Each member shall be appointed for a term of 6 years, except that the President shall stagger the terms of members initially appointed so that the term of no more than 3 members expires in any year.
    • (4) PROHIBITION ON CONFLICTS OF INTEREST- No member of the Board shall have a financial conflict of interest with the duties before the Board.
  • (b) Duties-
    • (1) IN GENERAL- The Board shall meet at least twice per year and shall advise the Secretary and the Director on a regular basis to ensure quality, access, and affordability.
    • (2) SPECIFIC ISSUES- The Board shall specifically address the following issues:
      • (A) Access to care.
      • (B) Quality improvement.
      • (C) Efficiency of administration.
      • (D) Adequacy of budget and funding.
      • (E) Appropriateness of reimbursement levels of physicians and other providers.
      • (F) Capital expenditure needs.
      • (G) Long-term care.
      • (H) Mental health and substance abuse services.
      • (I) Staffing levels and working conditions in health care delivery facilities.
    • (3) ESTABLISHMENT OF UNIVERSAL, BEST QUALITY STANDARD OF CARE- The Board shall specifically establish a universal, best quality of standard of care with respect to–
      • (A) appropriate staffing levels;
      • (B) appropriate medical technology;
      • (C) design and scope of work in the health workplace; and
      • (D) best practices; and
      • (E) salary level and working conditions of physicians, clinicians, nurses, other medical professionals, and appropriate support staff.
        • (4) TWICE-A-YEAR REPORT- The Board shall report its recommendations twice each year to the Secretary, the Director, Congress, and the President.
  • (c) Compensation, etc- The following provisions of section 1805 of the Social Security Act shall apply to the Board in the same manner as they apply to the Medicare Payment Assessment Commission (except that any reference to the Commission or the Comptroller General shall be treated as references to the Board and the Secretary, respectively):
    • (1) Subsection (c)(4) (relating to compensation of Board members).
    • (2) Subsection (c)(5) (relating to chairman and vice chairman)
    • (3) Subsection (c)(6) (relating to meetings).
    • (4) Subsection (d) (relating to director and staff; experts and consultants).
    • (5) Subsection (e) (relating to powers).



  • [Decide on VA after 10 years. Integrate Indian Health Service Programs after 5 years.]
  • (a) VA Health Programs- This Act provides for health programs of the Department of Veterans’ Affairs to initially remain independent for the 10-year period that begins on the date of the establishment of the Medicare for All Program. After such 10-year period, the Congress shall reevaluate whether such programs shall remain independent or be integrated into the Medicare for All Program.
  • (b) Indian Health Service Programs- This Act provides for health programs of the Indian Health Service to initially remain independent for the 5-year period that begins on the date of the establishment of the Medicare for All Program, after which such programs shall be integrated into the Medicare for All Program.


  • It is the intent of this Act that the Program at all times stress the importance of good public health through the prevention of diseases.


  • It is the intent of this 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.



  • Except as otherwise specifically provided, this Act shall take effect on the first day of the first year that begins more than 1 year after the date of the enactment of this Act, and shall apply to items and services furnished on or after such date. [Example: if the United States had established this law by 9/9/2009 would have meant that the United States would have had health care for all since 1/1/2011. Correspondingly, establishing this law by the fall of 2020 would mean that the United States would have universal health care on 1/1/2022.
    Let's get this national version "now" within years, not "later" within decades!


Reference Information

** Free-Market Countries 

Czech Republic
Korea, South
New Zealand
United Kingdom
United States

(Countries) classified as low-income
Countries without health care for all (universal healthcare).

** The above 30 free-market industrialized countries
are the set of countries referenced at this website. They are the 30 that joined the OECD during the time period of 1961 through 2009. See the OECD website to see their current list.


See the complete text of the resolution here:

Go to the Library of Congress index for H.R.676
and select “Printer Friendly Display.” You will not see a display of the entire text of H.R. 676 on one web page unless you select “Printer Friendly Display.”

One of the documents on which H.R. 676’s development was based was the 8-page document “Proposal of the Physician’s Working Group for Single-Payer National Health Insurance.”

Realistic Expectations

We need to have realistic expectations. For example, choices of physicians and facilities are dependent on availability. The degree of availability is applicable to any system, no matter how it is funded. No system is perfect. Fortunately, the United States has a current emphasis on training more health care providers. Due to more Americans getting health care, more providers will be needed. A degree of rationing is also applicable. Without national health insurance the United States has current rationing that is not just related to resources, but on what can be a complex combination of factors, such as these examples:
   -- ability to pay,
   -- what plan one has, and
   -- whether a physician or facility is in-network or out-of-network.

More on rationing is available.

Further Reading

Related web pages

Benefits of Improved Medicare for All compared to our current health care NOT for all system
Comparison of Medicare (for 65 yrs and older) to Improved Medicare for All (no exceptions)
Even more comparisons of other options to improved Medicare for All.

Cost Sharing

Extensive reporting about cost-sharing is available by doing a search for cost-sharing at Here are just a few examples of what PNHP provides:

Our Compliments and Thanks to You

Studying and asking and communicating about this subject contributes to our preparations for this change in our society. Thank you!.

  • We will know what to expect and help make it happen.
  • We will embrace (welcome) the change and help make it be a good one.
  • Those of us who participate in this important debate are making a valuable contribution to our society.

A critical objective is to have a public agency managing our national health insurance that is reportable to the people, not the day-to-day influence U.S. politicians and 50 sets of state politicians.

However, we need the U.S. politicians to establish the law! Thus, the politicians are involved at the start of this important aspect of our society! We need to help ensure that they represent US, the people, and that they establish a law that will be BEST for US, the people.

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Universal Health Care, Improved Medicare for All as per U.S. House Resolution 676
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