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American Health Security Act, S. 1782

April 2, 2015 by  

American Health Security Act, S. 1782

Introduced by Sen. Bernie Sanders.
Read the full bill from 113th Congress (2013-2014).
Read the summary of S. 1782 from the 113th Congress (2013-2014).
See the list of Congressional S. 1782 cosponsors for the 113th Congress (2013-2014).

Brief Summary of the Legislation

The American Health Security Act of 2013 (S. 1782) provides every American with affordable and comprehensive health care services through the establishment of a national American Health Security Program (the Program) that requires each participating state to set up and administer a state single payer health program. The Program provides universal health care coverage for the comprehensive services required under S. 1782 and incorporates Medicare, Medicaid, the Children’s Health Insurance Program, the Federal Employees Health Benefits Program and TRICARE (the Department of Defense health care program), but maintains health care programs under the Veterans Affairs Administration. Private health insurance sold by for-profit companies could only exist to provide supplemental coverage.

The cornerstones of the Program will be fixed, annual, and global budgets, public accountability, measures of quality based on outcomes data designed by providers and patients, a national data-collection system with uniform reporting by all providers, and a progressive financing system. It will provide universal coverage, benefits emphasizing primary and preventive care, and free choice of providers. Inpatient services, long term care, a broad range of services for mental illness and substance abuse, and care coordination services will also be covered.

A seven-member national board (the Board) appointed by the President will establish a national health budget specifying the total federal and state expenditures to be made for covered health care services. The Board will work together with similar boards in each of the fifty states and the District of Columbia to administer the Program.

A Quality Council will develop and disseminate practice guidelines based on outcomes research and will profile health care professionals’ patterns of practice to identify outliers. It will also develop standards of quality, performance measures, and medical review criteria and develop minimum competence criteria. A new Office of Primary Care and Prevention Research will be created within the Office of the Director of the National Institutes of Health (NIH).

The Program is designed to provide patient-centered care supported through adequate reimbursement for professionals, a wealth of evidence-based information, peer support, and financial incentives for better patient outcomes. The Program seeks to ensure medical decisions are made by patients and their health care providers.

The Program amends the tax code to create the American Health Security Trust Fund and appropriates to the Fund specified tax revenues, current health program receipts, and tax credits and subsidies under the Affordable Care Act. While the final structure of the financing component is still under consideration and is subject to change, the tax revenues in the draft include a new health care income tax, an employer payroll tax, a surcharge on high income individuals, and a tax on securities transactions.

The federal government would collect and distribute all funds to the states for the operation of the state programs to pay for the covered services. Budget increases would be limited to the rate of growth of the gross domestic product. Each state’s budget for administrative expenses would be capped at three percent.

Each state would have the choice to administer its own program or have the federal Board administer it. The state program could negotiate with providers and consult with its advisory boards to allocate funds. The state program could also contract with private companies to provide administrative functions, as Medicare currently does through its administrative regions. State programs could negotiate with providers to pay outpatient facilities and individual practitioners on a capitated, salaried, or other prospective basis or on a fee-for service basis according to a rate schedule. Rates would be designed to incentivize primary and preventive care while maintaining a global budget, bringing provider, patients, and all stakeholders to the table to best determine value and reimbursement.

Finally, the Program also relieves businesses from the heavy administrative burdens of providing health care coverage, puts all businesses on an even playing field in terms of healthcare coverage, and increases the competitiveness of American companies in the global marketplace. Every other industrialized nation has been able to use the power of a public authority to provide universal health care. The American Health Security Act of 2013 seeks to do just that for all Americans and their businesses.

Bernie Sanders introduces The American Health Security Act

December 11, 2013 by  

Introduced in the Senate, December 9, 2013

Download S. 1782, The American Health Security Act of 2013 (189 pages).

Summary of S. 1782, The American Health Security Act of 2013

The American Health Security Act of 2013 (S. 1782) provides every American with affordable and comprehensive health care services through the establishment of a national American Health Security Program (the Program) that requires each participating state to set up and administer a state single payer health program. The Program provides universal health care coverage for the comprehensive services required under S. 1782 and incorporates Medicare, Medicaid, the Children’s Health Insurance Program, the Federal Employees Health Benefits Program and TRICARE (the Department of Defense health care program), but maintains health care programs under the Veterans Affairs Administration. Private health insurance sold by for-profit companies could only exist to provide supplemental coverage.

The cornerstones of the Program will be fixed, annual, and global budgets, public accountability, measures of quality based on outcomes data designed by providers and patients, a national data-collection system with uniform reporting by all providers, and a progressive financing system. It will provide universal coverage, benefits emphasizing primary and preventive care, and free choice of providers. Inpatient services, long term care, a broad range of services for mental illness and substance abuse, and care coordination services will also be covered.

A seven-member national board (the Board) appointed by the President will establish a national health budget specifying the total federal and state expenditures to be made for covered health care services. The Board will work together with similar boards in each of the fifty states and the District of Columbia to administer the Program.

A Quality Council will develop and disseminate practice guidelines based on outcomes research and will profile health care professionals’ patterns of practice to identify outliers. It will also develop standards of quality, performance measures, and medical review criteria and develop minimum competence criteria. A new Office of Primary Care and Prevention Research will be created within the Office of the Director of the National Institutes of Health (NIH).

The Program is designed to provide patient-centered care supported through adequate reimbursement for professionals, a wealth of evidence-based information, peer support, and financial incentives for better patient outcomes. The Program seeks to ensure medical decisions are made by patients and their health care providers.

The Program amends the tax code to create the American Health Security Trust Fund and appropriates to the Fund specified tax revenues, current health program receipts, and tax credits and subsidies under the Affordable Care Act. While the final structure of the financing component is still under consideration and is subject to change, the tax revenues in the draft include a new health care income tax, an employer payroll tax, a surcharge on high income individuals, and a tax on securities transactions.

The federal government would collect and distribute all funds to the states for the operation of the state programs to pay for the covered services. Budget increases would be limited to the rate of growth of the gross domestic product. Each state’s budget for administrative expenses would be capped at three percent.

Each state would have the choice to administer its own program or have the federal Board administer it. The state program could negotiate with providers and consult with its advisory boards to allocate funds. The state program could also contract with private companies to provide administrative functions, as Medicare currently does through its administrative regions. State programs could negotiate with providers to pay outpatient facilities and individual practitioners on a capitated, salaried, or other prospective basis or on a fee-for service basis according to a rate schedule. Rates would be designed to incentivize primary and preventive care while maintaining a global budget, bringing provider, patients, and all stakeholders to the table to best determine value and reimbursement.

Finally, the Program also relieves businesses from the heavy administrative burdens of providing health care coverage, puts all businesses on an even playing field in terms of healthcare coverage, and increases the competitiveness of American companies in the global marketplace. Every other industrialized nation has been able to use the power of a public authority to provide universal health care. The American Health Security Act of 2013 seeks to do just that for all Americans and their businesses.

Obamacare’s Empty Victory

May 7, 2014 by  

By Margaret Flowers, M.D. for The Indypendent

It feels truly Orwellian that progressives are applauding the forced purchase of private health insurance — one of the most hated industries in the United States — while the right is opposing a model that originated from their political leaders. The Affordable Care Act (ACA) is a step farther on the path to total privatization of our health care system, not towards the health care system that most Americans support: single payer Medicare for all.

In the months leading up to the March 31 deadline to obtain health insurance, ACA supporters united around their mission to enroll people. Volunteers knocked on doors and tabled in their communities. Celebrities and athletes tweeted and labor unions ran robocalls. The media buzzed with speculation about whether the ACA would succeed or fail. March 31 felt like election night. And after it was over, ACA supporters clapped each other on the back and celebrated.

Obamacare survived. But now that the law is implemented and the dust is settling, it’s time to question what this actually means for health care and what we should do now.

Before President Obama was elected in 2008, Drs. David Himmelstein and Steffie Woolhandler, two of the co-founders of Physicians for a National Health Program, raised a crucial question in their report, “Our Health Care System at the Crossroads: Single Payer or Market Reform?” They outlined the health care crisis and how past reforms were taking us toward increasingly “threadbare insurance coverage.” Knowing that health care reform would be front and center for the next few years, they argued that as a nation, we had a choice to make. We could stay on the same path toward a market-based health care system or take an evidence-based approach and create national single payer health insurance.

With the ACA, we have now passed that crossroads and are headed down the road to a completely market-based system of privatized health care. This is not something to celebrate. Dr. Adam Gaffney recently wrote an excellent history in Jacobin on the turn we have taken away from the concepts of universal health care and economic justice to a neoliberal model. We are inundated with market rhetoric telling us how wonderful it is to have the choice of shiny silver insurance in the brand new marketplace. Insurance plans are called products and we are consumers of them.

The problem with these public relations messages is that having health insurance doesn’t guarantee access to health care and health care doesn’t belong in the marketplace. As patients, we do not have a choice of whether or not to purchase health care when we need it. Delaying or avoiding necessary care can and does have serious consequences. And we can’t predict how much health care we will need or when we’ll need it. In a market-based system, profits are the bottom line and people receive only the amount of health care they can afford, not what they need.

The ACA is transferring hundreds of billions of public dollars to the private insurance industry to subsidize plans that leave people underinsured, unable to afford care and at risk of financial ruin if they have a serious accident or illness. And even at its best, tens of millions of people will remain without insurance.

Most of the 7.5 million people who purchased health insurance on the exchanges were already insured. More than 80 percent bought the lower-tier silver, bronze or catastrophic plans with the hope that they would not get sick. These plans have the lowest premiums but require that patients pay thousands of dollars out of pocket before insurance kicks in, and then pay 30 to 40 percent of the cost of covered care. The result is that underinsured people will continue to self-ration, delay or avoid care due to cost, as 80 million of us did in 2012.

The ACA includes regulations, but as usual the insurance industry has ways to work around them. Many insurers had caps on out-of-pocket costs waived. Insurers also found a way to “cherry pick” the healthiest customers by leaving cancer centers and major medical centers out of their networks. In fact, most of the new plans have narrow and ultra-narrow networks that shift more of the cost of care onto patients because care outside of insurance networks isn’t covered. And while insurance companies cannot drop individuals when they get sick, they can stop selling their plans in areas that don’t make a profit. Some are already doing this, which means the competition that was supposed to emerge did not. Instead, in 515 of the poorest counties in 15 states, only one insurance company is available on the health exchange. And greater consolidation of the health care system is underway through mergers and acquisitions.

Our public insurances, Medicaid and Medicare, are being increasingly taken over by private insurances in the form of Managed Care Organizations and Medicare Advantage. They compete for the healthiest patients and siphon more of the health dollars for profit, salaries and administration than public insurances. Top advisors to the White House expect our public plans to be rolled into the health exchanges in the near future with subsidies, a plan similar to Congressman Paul Ryan’s voucher proposal.

Nations that treat health care as a public good and not a commodity have universal coverage that costs less and produces better health outcomes. And in polls, some two thirds of Americans support single payer. Now our tasks is to shift the national debate away from how many people have insurance to what type of health care system we support. Efforts to do this are taking place at both state and national levels.

State efforts to educate and organize for universal health systems are using a human rights framework. This started with the Health Care is a Human Right campaign in Vermont that is working to create universal coverage, and similar organizing is happening in Maine, Pennsylvania and Maryland. An essential component of this organizing model is to develop leadership within communities that are uninsured or underinsured. States such as Washington, Oregon, Colorado and New Mexico also use human rights messaging in their campaigns.

State health reform faces significant barriers because federal legislation is needed to allow the creation of a state single payer system. However, state campaigns are essential because they push state health policy to be the strongest it can be and build an informed and organized grassroots movement that can also push for solutions at the national level.

Legislation for single payer health systems exists in Congress. In the House, Congressman John Conyers (D-MI) has introduced HR 676, “The Expanded and Improved Medicare for All Act,” in every session since 2003. So far it has 56 co-sponsors. In late 2013, Senator Bernie Sanders (I-VT) introduced SB 1782, “The American Health Security Act,” in the Senate. National organizations are working together to encourage more members to sponsor them and a national lobby day is happening in Washington, D.C., on May 22.

On a personal level, I have chosen to be a conscientious objector to the ACA. I cannot in good conscience give my support to the very industry I am trying to eliminate. Being a conscientious objector is a decision that people have to make for themselves. So far nearly 500 people have joined me by signing a petition at PopularResistance.org.

Some people speculate that the ACA will bring us to single payer some day because it will fail. This will only happen if we fight for it. Every day that we delay, people suffer and die in this country unnecessarily. Neil H. Buchanan says it best, “The ACA is as good as it gets, when it comes to basing a health care system on private insurance, and it is simply not good enough. Even as the ACA takes effect, therefore, we need to start planning to make it disappear.”

Margaret Flowers is a pediatrician and co-chair of the Maryland chapter of Physicians for a National Health Plan. She serves on the board of Healthcare-Now and of the Maryland Health Care is a Human Right campaign. She is also an editor at popularresistance.org.

May 22, National Single-Payer Lobby Day!

April 2, 2014 by  

Thursday, May 22 will be the first national single-payer lobby day of the year, supported by Healthcare-NOW!, Physicians for a National Health Program, Public Citizen, the Labor Campaign for Single Payer, and others.

Can you schedule a meeting with your Representative and Senators for May 22? You can visit your legislators’ offices in Washington, D.C. or in your district. Email Ben today so we can coordinate meetings across our different organizations.

Meeting face-to-face and describing why you care so passionately about single-payer is the most effective way to get your legislator on board – better than a hundred emails or phone calls. Even more effective is to bring a group of friends!

This will be a great opportunity to add co-sponsors to John Conyers’s Improved and Expanded Medicare for All legislation, HR 676 and Bernie Sanders’s American Health Security Act, S 1782, which would guarantee comprehensive health care for every resident of the United States while reducing costs.

Don’t know who your legislators are? Go here. Email Ben for lobby materials, help identifying whether your Reps. have supported single-payer reform in the past, and how to schedule a meeting at their office.

Action Alert: Write a Letter to the Editor About Senate Healthcare Hearing

March 13, 2014 by  

On Tuesday, March 11, a Senate Subcommittee chaired by Bernie Sanders held an unprecedented hearing on what the U.S. can learn from countries with single-payer healthcare systems.

The evidence was overwhelming: expert after expert from Canada, Denmark, Taiwan, and France showed that single-payer costs less while virtually eliminating financial barriers to care for patients. Right-wing critics at the hearing pulled out every misleading myth about single-payer, only to have them debunked by the experts in real world health policy. Here are the highlights.

Can you please take a moment to write a letter to the editor at your local paper about this important Senate hearing? The rest of the country needs to know that single-payer reform, such as John Conyers’s HR676 in the House and Bernie Sanders’s S1782, is the only solution to our crisis of rising health care costs and poor access to care.

Please email us if you need help or if your letter is published.

Here’s a sample letter:

Subject: Congressional Hearing Shows Single-Payer Reform the Best Option

On Tuesday, a Senate Subcommittee – possibly for the first time in the history of Congress – hosted a long overdue hearing on “What the US Health Care System Can Learn from Other Countries.”

Health policy experts from France, Denmark, Canada, and Taiwan painted a startling picture: even after full implementation of the ACA the United States will spend more than any other developed nation, receive inferior access to care, and see similar or worse quality of care. We are the only wealthy country that does not publicly guarantee access to care through a “single-payer” system of universal coverage.

For me, this testimony highlights the tragic consequences of clinging to a for-profit health care system that the rest of the world has escaped from. Our system, despite the ACA, lets people with illness slip through the cracks with devastating consequences, and costs twice as much. It’s time to take the next step and implement guaranteed healthcare for all.

Take Action for Senate Single Payer Bill

March 10, 2014 by  

The cause of universal healthcare is alive and well. Not only is the state of Vermont moving toward a single-payer system, but Vermont’s U.S. Senator Bernie Sanders has introduced a bill and is holding a hearing this week on the benefits other countries enjoy from a single-payer system that would benefit everyone except the profiteering middlemen who’ve rigged the current system.

Click here to ask your senators to cosponsor and support. This is a joint action with RootsAction.

“The United States is the only major nation in the industrialized world that does not guarantee healthcare as a right to its people,” Sanders said. “It is time that we bring about a fundamental transformation of the American healthcare system. It is time for us to end private, for-profit participation in delivering basic coverage.”

The bill, S. 1782, the American Health Security Act, would be a much more significant change to health coverage than those recently implemented. It would create a much simpler, less wasteful system of paying for healthcare, one that’s in fact been tested in every other industrialized nation in the world, every one of which buys more healthcare for less money than we do in the United States.

The current system remains so broken that change must come. The question is how slowly and how piecemeal, and with how much unnecessary suffering along the way.

Join us in speaking up for universal coverage now!

Please forward this email widely to like-minded friends.

Labor Builds Support for Medicare for All

January 27, 2014 by  

Comments Off on Labor Builds Support for Medicare for All

While Obamacare Enrollment Continues to Lag, Labor Builds Support for Expanded and Improved Medicare for All

By Pearl Korn for Huffington Post

The 113th Congress will likely be remembered as the most unproductive in our history, and with an overall approval rating of 9 perent, it is safe to say that most Americans do not consider this bunch to be a noble group of public servants engaged in good works for the people of this country. It is rare that any member of Congress is honored on any level these days, but one truly worthy exception is Rep. John Conyers (D-MI), who early in December was honored with a breakfast celebration attended by some 40 union representatives at a restaurant on East 29th Street in New York City.

Those present included leaders from Actors Equity, The International Alliance of Theatrical Stage Employees (IATSE) and the New York City Central Labor Council (NYCCLC), whose President, Vincent Alvarez, declared his support for Mr. Conyers’ bill HR 676, The Expanded and Improved Medicare for All Act, and promised to deliver their 1.3 million members to back this cause. This is a very significant development, as the 300 unions under the umbrella of the NYCCLC are made up of truck drivers, teachers, nurses, operating engineers, construction workers, janitors, train operators, electricians, fire fighters, retail workers and many more hardworking Americans who, along with everyone else in our nation, would benefit greatly from this revolutionary healthcare plan. They are the face of American labor today, and Mr. Alvarez spoke of the need for labor and the general public to unite and work together for this imperative cause: providing affordable, quality healthcare to all Americans.

We might recall that it was labor that gave us the middle class during the post World War II years as they worked to indeed lift all boats in that time of unprecedented prosperity. Can they lead our nation once again in this time of unprecedented need? They have been taking quite a beating, and have been decimated in several states by the lackeys of the 1 percent. But their values are America’s values, and it is critical that they remain a vibrant force for change in this country.

Mr. Conyers was introduced by his longtime friend, TV talk show host Phil Donahue, and other speakers that morning included Robert Score, Recording-Corresponding Secretary of Local 1 of IATSE, and Stephen Shaff, speaking on behalf of Progressive Democrats of America. Mr. Conyers himself noted that it took him 15 years to move Congress to declare a national holiday for Dr. Martin Luther King, so he is prepared for a long haul to achieve Medicare For All. He has reintroduced HR 676 in every Congress since 2003, and has now garnered support from 54 other House members, along with an impressive 609 union organizations, including 146 Central Labor Councils/Area Federations and 44 State AFL/CIO’s. Obamacare’s failure to address the Taft Hartley Plans and the operating procedures under which they work could create even more union support for the Single Payer movement. The president must address this issue.

Meanwhile, support from the public also continues to build, as the warts on the ACA become more apparent and the questions about its viability grow louder on almost a daily basis. This will undoubtedly drag into the 2014 election and continue to send shock waves throughout the political world into the 2016 race for the White House, as the Conservatives will remain active in their attacks and continuing efforts to end Obamacare.

Following the breakfast, Mr. Conyers and his policy director Mike Darner met with 15 of his core Single Payer activist leaders from organizations like Physicians For A National Health Program and Healthcare-Now! — as well as some doctors — to discuss strategy and continue building the movement. This group is definitely in it for the long haul, too, as they have supported Mr. Conyers and his bill for years. This is a bill that would deliver all necessary health services at less than half the cost we pay now, eliminating co-pays, deductibles and co-insurance while providing long-term care — including all of those expensive dental specialties. The estimated savings would be in the range of $592 billion a year. Better healthcare at lower costs — what’s not to like? And if you like your doctor, you actually could keep him or her — did you hear that, Mr. President? You can also pick any doctor you like — no more provider networks. These healthcare professionals would be able to become doctors once again, instead of a “provider” or “vendor,” and we could become patients again, ending our dehumanizing role as a “consumer” or “customer.”

Of late, we have been reading about Medicare For All from such luminaries as Robert Reich, Ralph Nader and William Greider in The Nation, among others. Even Bill Clinton mentioned it during President Obama’s second campaign. If Hillary were to acknowledge that Medicare For All is the next logical step after Obamacare, she would gain tremendous support and a second opportunity to get the right healthcare plan in place for her presumed 2016 run for president. Unfortunately, Hillary has proven herself to be far from progressive on many issues in the past, so we will have to wait and hear from her what her healthcare plan actually is if she decides to run.

Meanwhile, in the past few weeks Vermont Senator Bernie Sanders and Rep. James McDermott (D-WA) — who is also a doctor — have both introduced Single Payer bills. Bernie’s bill is a Medicare-for-All proposal known as the American Health Security Act of 2013 (S.1782), which would be administered by the states and transferable between states. The McDermott bill also moves the initiative outside of D.C., leaving it up to the states to develop their own plans based on their diversity and individual needs. As Massachusetts was the template for the ACA, it makes sense to finally introduce Single Payer on a state-by-state level.

Vermont has approval in both of its houses for a Single Payer plan, but it needs a waiver from the ACA to implement it in 2017. Can’t the federal government speed up that process? There are also plans at the ready in New York and in Rep. McDermott’s home state of Washington. And what of California, which has come so close in the past? One state can lead the country toward this monumental goal, the way Massachusetts did with the ACA. We just need to find the will.

In the Greider article in this month’s The Nation, entitled “Reviving The Fight For Single Payer,” he raises the question many of us ask: Can Obamacare deliver what it promised? One of the major problems he notes is that “…the reformed system will also still rely on the market competition of profit-making enterprises, including insurance companies.” Rep. McDermott was interviewed for this article, and he pointed out another major flaw in the ACA: “In the long arc of healthcare reform, I think [the ACA] will ultimately fail, because we are trying to put business-model methods into the healthcare system. We’re not making refrigerators. We’re dealing with human beings, who are way more complicated than refrigerators on an assembly line.”

Rep. McDermott – an advocate for Single Payer for decades – further wondered if hospitals will become “too big to fail” as they continue to merge and buy up private practices, and continue hiring younger doctors as salaried employees. Mr. Greider also made the following revelation: “An AMA survey in 2012 found the majority of doctors under 40 are salaried employees.” Rep. McDermott sees the troubling direction of this trend, noting that many new doctors “…will simply be serfs working for the system,” and Mr. Greider referred to another key point in the AMA research, noting that “…hospitals focus on employing primary-care physicians in order to maintain a strong referral base for high-margin specialty service lines.” Mr. Greider added further insight from Rep. McDermott: “Big hospitals need a feeder system of salaried doctors, McDermott explained, to keep sending them patients in need of surgery or other expensive procedures.” Even so, Rep. McDermott remains optimistic that stronger health care systems resembling Single Payer will spring up moving forward.

The New York Daily News offered a scathing editorial on December 24th entitled “Can This Patient Be Saved?” in which we were given a blow-by-blow analysis of the devastatingly mishandled rollout of the Obamacare exchanges and the problems millions of Americans have been having signing up for them. The situation was so bad that the deadline was extended until Christmas Eve for those to sign up who wanted their insurance to kick in on January 1, 2014. The CBO projects seven million will sign up in 2014, in addition to the about 1.1 million this year — well below the Administration’s projections. Meanwhile, millions will be losing their current plans due to the mandate. The question of more people losing their insurance than gaining it as a result of the president remaking the “healthcare economy” was also raised in this Op Ed piece.

Key provisions of the bill have already been waived in the past three years since its passage, and an additional postponement of the requirement for companies with fifty or more employees to offer health insurance or pay a tax penalty has now been postponed until 2015.

The individual mandate requiring most Americans to find coverage by April is also waiving penalties for those who had insurance and lost it this year. Most glaring in this critical article is the fact that there is “little reliable” information on who is getting what as far as coverage is concerned, and at what cost. The even larger question is, will those younger and healthier people opt in at all? If not, financially this boondoggle will sink. Obamacare is counting on them.

As the tinkering continues on the ACA, a major architect of this mess has just been rewarded by the president with an ambassadorship offer to China. Senator Baucus, do you not know the meaning of the word “retire?”

All good wishes for a (hopefully) healthy and happy New Year!

– with Jonathan Stone