The following is an executive summary of the US National Health
Insurance Act (HR676).
Expanded & Improved Medicare For All Bill
to be introduced by Cong. John Conyers, 108th Congress
Brief Summary of Legislation
The United States National Health Insurance Act (HR676)
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.
With over 42 million uninsured Americans, and another 40 million
who are under insured, the time has come to change our
inefficient and costly fragmented health care system. The USNHI
program would reduce overall annual health care spending by over
$50 billion in the first year. In addition, because it
implements effective methods of cost-control, health spending is
contained over time, ensuring affordable health care to future
In its first year, single-payer will save over $150 billion on
paperwork and $50 billion by using rational bulk purchasing of
medications. These savings are more than enough to cover all the
uninsured, improve coverage for everyone else, including
medication coverage and long-term care.
Employers who currently provide coverage for their employees pay
an average of 8.5% of payroll towards health coverage, while
many employers can’t afford to provide coverage at all. Under
this Act, all employers will pay a modest 3.3% payroll tax per
employee, while eliminating their payments towards private
health plans. The average cost to an employer for an employee
earning $35,000 per year will be reduced to $1,155, less than
$100 per month.
95% of families will pay less for health care under national
health insurance than they do today. Seniors and younger people
will all have the comprehensive medication coverage they need.
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 i.d number once they enroll at the
appropriate location. Social Security numbers may not be used
when assigning i.d cards. No co-pays or deductibles are
permissible under this act.
This program will cover all medically necessary services,
including primary care, inpatient 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
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
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.
Funding & Administration
The United States Congress will establish annual funding outlays
for the USNHI Program through an annual entitlement. The USNHI
program will operate under the auspices of the Dept of Health &
Human Services, and be administered in the former Medicare
offices. All current expenditures for public health insurance
programs such as S-CHIP, Medicaid, and Medicare will be placed
into the USNHI 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: $1.86 Trillion Per Year
A payroll tax on all employers of 3.3%. Maintain employee and
employer Medicare payroll tax of 1.45%. Implement a variety of
mechanisms so that low and middle income families pay a smaller
share of their incomes for health care than wealthiest 5% of
Americans; i.e, a health income tax on the wealthiest 5% of
Americans, a small tax on stock and bond transfers, and closing
corporate tax shelters. A repeal of the Bush tax cut of 2001.
For more details, see PNHP’s “Financing National Health