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View Diary: Netroots Nation: Let's Write a Platform! (UPDATED) (47 comments)

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  •  HR 1200, the American Health Security Act (0+ / 0-)

    SEC. 201. COMPREHENSIVE BENEFITS
    (a) if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:

    (1) HOSPITAL SERVICES- Inpatient and outpatient hospital care, including 24-hour-a-day emergency services.

    (2) PROFESSIONAL SERVICES- Professional services of health care practitioners authorized to provide health care services under State law, including patient education and training in self-management techniques.

    (3) COMMUNITY-BASED PRIMARY HEALTH SERVICES- Community-based primary health services (as defined in section 202(a)).

    (4) PREVENTIVE SERVICES- Preventive services (as defined in section 202(b)).

    (5) LONG-TERM, ACUTE, AND CHRONIC CARE SERVICES-

    (A) Nursing facility services.

    (B) Home health services.

    (C) Home and community-based long-term care services (as defined in section 202(c)) for individuals described in section 203(a).

    (D) Hospice care.

    (E) Services in intermediate care facilities for individuals with mental retardation.

    (6) PRESCRIPTION DRUGS, BIOLOGICALS, INSULIN, MEDICAL FOODS-

    (A) Outpatient prescription drugs and biologics, as specified by the Board consistent with section 615.

    (B) Insulin.

    (C) Medical foods (as defined in section 202(e)).

    (7) DENTAL SERVICES- Dental services (as defined in section 202(h)).

    (8) MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT SERVICES- Mental health and substance abuse treatment services (as defined in section 202(f)).

    (9) DIAGNOSTIC TESTS- Diagnostic tests.

    (10) OTHER ITEMS AND SERVICES-

    (A) OUTPATIENT THERAPY- Outpatient physical therapy services, outpatient speech pathology services, and outpatient occupational therapy services in all settings.

    (B) DURABLE MEDICAL EQUIPMENT- Durable medical equipment.

    (C) HOME DIALYSIS- Home dialysis supplies and equipment.

    (D) AMBULANCE- Emergency ambulance service.

    (E) PROSTHETIC DEVICES- Prosthetic devices, including replacements of such devices.

    (F) ADDITIONAL ITEMS AND SERVICES- Such other medical or health care items or services as the Board may specify.

    (b) Cost-Sharing-

    (1) IN GENERAL- Except as provided in this subsection, there are no deductibles, coinsurance, or copayments applicable to acute care and preventive benefits provided under this title.

    (2) COST-SHARING FOR LONG-TERM CARE SERVICES-
    ...

    (i) payments for home and community-based long-term care services are subject to coinsurance of 20 percent; and

    (ii) payments for nursing facility services are subject to coinsurance of 35 percent.

    ...
    (i) such coinsurance shall not apply to an individual with income (as defined by the Secretary) of not more than 100 percent of the income official poverty line applicable to a family of the size involved; and

    (ii) in the case of an individual with such income that exceeds 100 percent, but is less than 200 percent, of such applicable poverty line, the coinsurance shall be reduced in the same proportion as the proportion of such income is less than 200 percent of such applicable poverty line.
    ....
    (e) State Program May Provide Additional Benefits...at the expense of the State.

    (f) Employers May Provide Additional Benefits...to employees or their dependents, or to former employees or their dependents.

    SPECIFIED PREVENTIVE SERVICES
    (A) Basic immunizations.

    (B) Prenatal and well-baby care (for infants under 1 year of age).

    (C) Well-child care (including periodic physical examinations, hearing and vision screening, and developmental screening and examinations) for individuals under 18 years of age.

    (D) Periodic screening mammography, Pap smears, and colorectal examinations and examinations for prostate cancer.

    (E) Physical examinations.

    (F) Family planning services.

    (G) Routine eye examinations, eyeglasses, and contact lenses.

    (H) Hearing aids ...[ by prescription]

    Dental Services
    (1) IN GENERAL- In this title, subject to subsection (b), the term `dental services' means the following:

    (A) Emergency dental treatment, including extractions, for bleeding, pain, acute infections, and injuries to the maxillofacial region.

    (B) Prevention and diagnosis of dental disease, including examinations of the hard and soft tissues of the oral cavity and related structures, radiographs, dental sealants, fluorides, and dental prophylaxis.

    (C) Treatment of dental disease, including non-cast fillings, periodontal maintenance services, and endodontic services.

    (D) Space maintenance procedures to prevent orthodontic complications.

    (E) Orthodontic treatment to prevent severe malocclusions.

    (F) Full dentures.

    (G) Medically necessary oral health care.
    ....

    Mental Health
    and Substance Abuse Treatment Services-
    ...
    (A) INPATIENT HOSPITAL SERVICES
    (B) INTENSIVE RESIDENTIAL SERVICES- ... up to 120 days during any calendar year...
    (C) OUTPATIENT SERVICES- Outpatient treatment services of mental illness or substance abuse
    ....

    SEC. 631. MANDATORY ASSIGNMENT
    (a) No Balance Billing- Payments for benefits under this Act shall constitute payment in full for such benefits and the entity furnishing an item or service for which payment is made under this Act shall accept such payment as payment in full for the item or service and may not accept any payment or impose any charge for any such item or service other than accepting payment from the State health security program in accordance with this Act.

    (b) Enforcement- If an entity knowingly and willfully bills for an item or service or accepts payment in violation of subsection (a), the Board may apply sanctions against the entity in the same manner as sanctions could have been imposed under section 1842(j)(2) of the Social Security Act for a violation of section 1842(j)(1) of such Act. Such sanctions are in addition to any sanctions that a State may impose under its State health security program.

    SEC. 615. PAYMENTS FOR PRESCRIPTION DRUGS
    ...
    (1) IN GENERAL- The Board shall establish a list of approved prescription drugs and biologicals that the Board determines are necessary...

    (2) EXCLUSIONS- ...ineffective, unsafe, or over-priced products where better alternatives are determined to be available.

    (b) Prices- ...the Board shall from time to time determine a product price or prices which shall constitute the maximum to be recognized under this Act as the cost of a drug to a provider thereof. The Board may conduct negotiations, on behalf of State health security programs, with product manufacturers and distributors in determining the applicable product price or prices.

    (c) Charges by Independent Pharmacies- ...based on the drug's cost to the pharmacy...plus a dispensing fee...taking into account...differences in the volume of prescription drugs dispensed...

    SEC. 811. PAYROLL TAX ON EMPLOYERS.

    [8.7 percent]

    SEC. 59B. HEALTH CARE INCOME TAX.

    [2.2 percent of the taxable income of the taxpayer for the taxable year]

    SEC. 821. INCREASE IN EXCISE TAXES ON TOBACCO PRODUCTS.

    Every Federal candidate should support HR 1200, the American Health Security Act. HR 1200 with an Oregon style efficacy rating system added is the most likely long-term future health system in my opinion.

    A transition to HR 1200 relying on Medicare will probably be needed. People could pay for a three month period of Medicare coverage by sending in an age-based premium like they do with estimated taxes, but about a month in advance so they can get a three-month Medicare card in time. People needing subsidies could just go to a welfare office or health department and pay whatever their share is with a check, cash, or a postal money order, the agency would make up the difference in a check to the IRS.

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