Single Payer/HR 676

H.R. 676
Expanded & Improved Medicare For All Act

Introduced by Rep. John Conyers in 2003.
Read the full bill (.pdf) – only a fraction of the length of the ACA!.
See the full list of Congressional HR 676 cosponsors here.

Brief Summary of the Legislation

Expanded & Improved Medicare For All Act establishes a unique American national universal health insurance program. The bill would create a publicly financed, privately delivered healthcare system 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 everyone will have access, guaranteed by law, to the highest quality and most cost effective healthcare services regardless of their employment, income, or healthcare status.

Who is Eligible?

Every person living or residing 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.

Healthcare Services Covered

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 practices. No co-pays or deductibles are permissible under this act.

Conversion To A Non-Profit Healthcare System

Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the single payer program. Those who are displaced as the result of the transition to a non- profit healthcare system are the first to be hired and retrained under this act.

Cost Containment Provisions/Reimbursement

The single payer program as set forth in HR 676 will set reimbursement rates annually for physicians, allow for global budgets (annual lump sums for operating expenses) for healthcare providers; and negotiate prescription drug prices. A “Medicare For All Trust Fund” will be established to ensure a dedicated stream of funding, as well as an annual appropriation to ensure optimal levels of funding for the program.

HR 676 Would Save $400 billion

The U.S. could save enough on administrative costs with a single-payer system to cover the uninsured.

Physicians for a National Health Program (PNHP) Co-founders Drs. Steffie Woolhandler and David Himmelstein published this definitive study of the administrative costs of the U.S. health system in the August 21, 2003 edition of the New England Journal of Medicine. After analyzing the costs of insurers, employers, doctors, hospitals, nursing homes and home-care agencies in both the U.S. and Canada, they found that administration consumes 31.0 percent of U.S. health spending, double the proportion of Canada (16.7 percent). Average overhead among private U.S. insurers was 11.7 percent, compared with 1.3 percent for Canada’s single-payer system and 3.6 percent for Medicare. Streamlined to Canadian levels, enough administrative waste could be saved to provide compressive health insurance to all Americans. You can read the study here.

This $400 billion dollars in savings could be used to eliminate co-pays and deductibles, and to improve and expand current coverage to include dental care, vision, and mental health. Even with these additions, the savings are still projected to be over $50 billion per year.

Proposed Funding For HR 676 Program*

Maintain current federal and state funding for existing healthcare programs; employer payroll tax of 4.5%, an employee payroll tax of 3.3%, in addition to the already existing 1.45% for Medicare; establish a 5% health tax on the top 5% of income earners; 10% tax on top 1% of wage earners, 1/3rd of 1% stock transaction tax, closing corporate tax loop-holes; repeal the Bush tax cut for the highest income earners.

*This proposal is put forward by single-payer advocates as one example of a funding system, though HR 676 doesn’t propose a funding program.

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