Bernie Sanders introduces The American Health Security Act

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.


  1. Sue Saltmarsh on December 11, 2013 at 3:18 pm

    Bravo, Senator Sanders! Though the name and much of the substance is the same as the companion bill introduced by Senator Sanders and Rep. Jim McDermott in 2011, this version may fare better due to the increased (and escalating) interest in alternatives to the ACA. It was referred to the Committee on Finance and I urge all supporters of single-payer healthcare to contact their senators, especially Republicans, and pressure them to support it. If we have a loud, rapid, relentless response, we can be our own lobbyists!

  2. Angie on December 12, 2013 at 12:13 am

    There should be no supplemental policies needed at all. Healthcare should be 100%. People will still lose homes and cannot afford the supplement policies or out of pocket co-pays. In addition policies often get lapsed due to illnesses or money problems and then the cost becomes a disaster for families. I don’t see the need to incur new taxes to cover the healthcare either if you the government would quit giving money to Exxon and Chevron and Monsanto and the like. Take away their tax breaks. Tax our resources and take away the working class income tax. Healthcare needs to be kept simple and straight forward. Insurance companies will still not cover all things for the people so what good can they really be. Insurance companies have forever complicated and made things confusing for the policy holders. Do not give the insurance companies yet another way to corrupt the system. We would still go the the hospital and they would ask, what kind of supplement do you carry before asking what is wrong with you. Healthcare is too important to us all to allow corporations any input with Americans health dollars. Our hard earned dollars need to all be used on healthcare and not wasted. Insurance companies can go into green sustainable jobs. If a business does not really serve the best interest of the public they should get into another business. On another vein lets not let the world rape Alaska like everywhere else. Use the suns energy the fossil fuel companies have enough money. Quit letting our food, water and air be made deadly to all living things. The world is now not so slowly being killed by many different man made factors. Without honey bees even the rich and the governemt will have no food only money and I don’t think you will like eating and drinking money.

    • Hank Bennett on December 12, 2013 at 3:15 pm

      Angie – I agree with you that no supplementary policies should be required. National coverage should cover EVERY medical issue, including vision, hearing, rehabilitatioin. We should totally eliminate the need for the REAL death panels in our health system – the health insurance companies!

  3. leftover on December 12, 2013 at 8:17 am

    Compared to the HR 676 summary posted at…

    …this “summary” seems awfully vague. And the funding sounds particularly enigmatic compared to the funding proposal for HR 676…

    …which should be enough to convince anybody of the economic benefits of the Conyers bill.
    Maybe I just don’t trust Bernie after last time.

  4. R Vincent Davis on December 12, 2013 at 3:33 pm

    Although this proposal needs more work, the idea is desirable. If crafted more in line with 676, would be better. Good idea to incorporate all systems stated under one system roof. Thanks Bernie

  5. T. Borreson on December 12, 2013 at 3:42 pm

    The fact that Sanders has introduced his bill now, at the end of the year just before Congress adjourns for the year, means that Sanders does not really expect the bill to go anywhere.

  6. D. Michaels on December 12, 2013 at 4:37 pm

    Supplemental insurance (or anything health care related) sold by insurance companies needs to go the way of the dinosaurs. It’s an impediment to care in far too many cases (including some where it professes to help like many supplemental and “advantage plans”) and allowing extra coverage for some would lead back to creating a system where some get better access than others or some of us have no little or no access because we don’t have that insurance.

    And haven’t block grants and mandates taught us anything? State mandates leave us with a patch work system where some states do wonderful things and others do crap that – at best – might (barely) pretend to meet the letter and/or intent of the grant or mandate while wholly and completely failing to do anything for those it’s supposed to be helping. This REALLY needs to be national – no if’s, and’s or but’s. Sure there’s going to be caterwauling about things like “state’s rights” but what about human rights? Don’t we get those at some point?

  7. Yeomantry on December 12, 2013 at 4:54 pm

    Like leftover, I don’t have much trust in Sanders either. Nor have I had time to wade through his bill. I do support HR 676 and looked through the Friedman study.

    If we are serious about single payer, the only way to get a ‘mandate’ from the public is to have the increased payroll taxes be less than current health insurance costs. There should be a net financial benefit to both the employee and the employer or it will never fly. Not only would that be wildly popular, it would help the overall economic recovery if everyone had a little more left in their paycheck. In fact, that is one of my objections to the current bottomless pit of healthcare costs – it has acted as a tax, slowing other spending.

  8. clyde winter on December 12, 2013 at 6:19 pm

    Some of the preceding comments may reflect an uninformed or ill-advised kneejerk reaction. In Sander’s proposed bill (as in HR 676) insurance would continue to be legally available for purchase from private for-profit corporations for such “medical care” as age-denying cosmetic surgery, luxury spas, or for otherwise scientifically unproven or discredited “treatments”.
    Both Sander’s bill and HR 676 actually prohibit the establishment of parallel, for-profit, class-based health care systems that cherry-pick affluent patients able to pay their way to favored status and first priority health care. Neither Sanders bill nor HR 676 allow for-profit insurance corporations to “insure” or be the gatekeepers restricting access to any comprehensive quality health care. However, both proposed reforms have become less effective than they once might have been in solving the current and continuing health care crisis.

    After the absolute failure of “our” corporate controlled government, and the outrageous refusal of the bosses of BOTH corporate controlled political parties, to even make a pretense of discussing publicly, much less seriously considering, the obvious, clear and simple solution to the health care crisis in America, which is Medicare For ALL, it became necessary to look a little more closely at the problem. And it is increasingly clear that simply socializing the administration of health care will no longer solve our health care crisis. Corporate control of the entire spectrum of health care provision in the USA has metastasized and progressed to such a terminal stage, that the only cure to the health care crisis in America is now to socialize medicine itself. Simply socializing the insurance and the administration of health care will no longer succeed in placing the cancer in remission.

    Corporate control and the unbridled greed of the super-rich succeeded in staving off a moderate, simple, obvious solution to the health care crisis in 2009-10. But that’s not the first time they blocked the door. It happened twenty years ago, too. And before that, almost 50 years ago. Indeed, the scumbag aristocrats and plutocrats succeeded in preventing a solution to the health care crisis exactly a century ago, when Teddy Roosevelt of the Progressive/Bull Moose Party campaigned for the presidency on a platform plainly endorsing comprehensive socialized, health care FOR ALL Americans by expanding and extending the existing hospital and health care system that had been established half a century before that for military personnel and veterans. Officials of both the Republic Party and the Democratic Party at that time were no more willing to embrace that platform plank a hundred damn years ago than they are willing to even talk about it today, despite the fact that virtually the entire so-called “developed” world today has adopted that Bull Moose Party platform plank as national policy and practice.

    The answer to the questions “WHY NOT YET?” and “WHY NOT IN THE USA?” is that we the people have not yet become sufficiently informed and organized and unwavering enough to overcome the increasing and now almost total control of both permitted major political parties and all branches of what should be our state and federal governments by corporations, the super-rich, and their associations.

    As bad and ominous as the health care crisis has become in the USA, with almost complete control of all aspects of medical care now in the hands of profit-seeking mega-corporations, this crisis is merely one of the symptoms, one of the clues, of what the future holds for the people and for life itself on this planet, if the people fail to establish and then defend democracy and government that is truly of, by, and for the people.

    The struggle will get more difficult and more desperate, the longer that we wait to do what needs to be done.

    If socialized medicine is good enough, right now, for our active duty troops and their families – indeed, if it’s good enough for our Presidents and our Supreme Court Justices and their families – then it’s damn sure good enough for all the rest of us.

    A corporation is NOT a person.
    Money is NOT speech.

    • grace kesslick on December 13, 2013 at 10:31 am

      I support “Medicare for all” on many bases, including the fact that by insuring everyone (via a tax + affordable monthly payment similar to those currently paid by workers and Medicare recipients) we help preserve the integrity of the Medicare system and allow for a means to control costs. Unless we get rid of corporate profiteering that takes not only from subscribers but also from medical facilities and providers in order to line their own pockets, we will never control costs. There is no such thing as “enough” from the corporate perspective. We need a single-payer system and we have one. Let’s be smart and use it–no more “enrollment” fiascos (a la ACA).


      • Yeomantry on December 13, 2013 at 2:45 pm

        Well said.

        Conservatives talk free markets for people who can’t afford care, but ignore the fact that the current system is the result of captured market profiteering. Unfortunately, the Obama detour has made the problem worse. While we’ve spun our wheels on truly affordable healthcare, there has been a further monopolization and entrenchment of Big Finance healthcare. It will not be adequate to do, as I think Sanders may be suggesting, to focus on running the worker-hamsters harder to pay for it all. We need to reverse the harm being done so that there are providers left to choose from and not a monolithic recipient of endless tax dollars. Let’s not let finance create too-big-to-fail healthcare that delivers profits better than care.

      • clyde winter on December 14, 2013 at 1:48 am

        I have supported the concept of HR 676, strengthened Medicare for ALL, before that bill was first introduced by one of our finest members of Congress ever, the truly honorable John Conyers, and before Healthcare – NOW! was founded. But we must recognize that the insurance corporation administered health care system in the USA has been swallowed up, lock, stop, and barrel, by for-profit corporations in recent decades. Medical professionals are now virtually all employees or captured contractors of large corporate chains. County hospitals and municipal clinics, once dedicated to serving the health care needs of the community, and accountable to the citizens, have been privatized and are now dedicated to serving the corporate bottom-line and the compensation package demands of their top executives. Hospitals originally established and run by religious or charitable organizations to serve the people are now operated strictly as businesses, by and for business school trained executives. Profit centers have proliferated within and attached to hospitals, owned and operated by entities motivated by maximizing profits, regardless of inherent conflicts of interest with optimizing patient care and cost control. We need to ask the hard question – will it be enough to simply socialize the administrative gatekeeper to an otherwise fully corporate dominated, controlled, and operated for-profit health care system?

        And be advised, Grace, that right here in the USA, we actually have five (not one) single-payer systems, each of which is a worthy model to learn from, emulate, and build upon, and each of which is far superior (in terms of both demonstrated quality of care and control of costs) to the for-profit corporate controlled, employer’s-choice or you’re-on-your-own system.

        One (as you point out) is Medicare, currently limited to people who are over 65 and the disabled.
        Two is the Veterans Administration serving many military veterans who are neither on active military duty nor retired from the military.
        Three is the Public Health Service, which, beginning in the second half of the 20th century, has been shrunk and dismantled in compliance with insistent demands of profit-seeking corporations.
        Four is the Indian Health Service, which serves people who are surviving descendants of indigenous nations which were here long before the European invasion and colonization of the Western Hemisphere.
        Five is Tricare, the existing health care system for active duty or retired military personnel and their families.

        I especially commend the fifth of these U.S. single payer health care systems – the Dep’t of Defense Tricare system which is completely socialized health care, from stem to stern, and which includes Bethesda and Walther Reed Hospitals – to the attention of all people who are truly concerned with the private for-profit health care crisis in the United States. And it is this system to which I refer when I assert that if socialized medicine is good enough for our active duty military personnel and their families, then it is damn sure good enough for all the rest of us.

        • Yeomantry on December 14, 2013 at 4:41 pm


          “We need to ask the hard question – will it be enough to simply socialize the administrative gatekeeper to an otherwise fully corporate dominated, controlled, and operated for-profit health care system?”

          Reform can’t limit itself to rearranging revenue streams without addressing the systemic profiteering increasingly built in. Reform has to look at the 100s of billions spent in finance alone to build-out hospitals and clinics across the country, the limitless budgets for technology without any attempts to correspond that profitable enterprise with affordability for patients and taxpayers. No attention has been paid to access beyond blaming people for not keeping up. But all the financial growth has come at the expense of ordinary people whose wages are supposed to be able to afford this care. The system is dis-eased, out of balance, and politicians are unwilling to admit that it is a profit system now, not a system of care.

  9. John Barker on December 13, 2013 at 1:39 pm

    I agree that we need one comprehensive national healthcare system. Bernie Sanders S1782 might be the Senate version of HR676 but allowing states to administer 50 varieties of HR676 isn’t ideal. Many states could opt to use healthcare funds to fix the health of their budgets and for corporate health rather than the health care of their citizens. Remember though that Bernie Sanders is one of those who believe that the only way we will get single payer in this country is for individual states to enact single payer as was done in Canada and I think S1782 reflects that. I would like however, for the Senate to rubber stamp HR676 but that isn’t the way it is usually done.

  10. Bonnie Boggs on December 15, 2013 at 5:14 pm

    Thank you for all you do.

  11. Bonnie Boggs on January 1, 2014 at 1:10 pm

    What is going on? We want Single Payer Health for all.