Appendix B Summary and Analysis of the National Health Care Services Reorganization and Financing Act - H.R. 1 Summary and Analysis of the National Health Care Act of 1975 H.R. 5990 - Summary and Analysis of the Catastrophic Health Insurance and Medical Reform Act H.R. 10028 The National Health Security, H. R. 21, program was introduced in the 94th Congress by Congressman Corman (D-Calif.) with 7 cosponsors from the Ways and Means Committee and with a total of 102 cosponsors in the House of Representatives. The bill would establish a comprehensive national health insurance program for all residents of the United States financed by a combination of payroll taxes and federal general revenues. H. R. 21 is supported by labor and 40 other organizations including some providers organizations and church groups, consumer groups, membership organizations and welfare groups. The bill would consolidate the financing of health services through a Health Security Board under the direction of the Secretary of Health, Education and Welfare in order to establish a national health expenditures budget to control medical care costs. Eligibility: Every citizen and permanent resident of the United States would be eligible for Health Security benefits. Unlike other proposals there would not be one plan for working people, another for those who are unemployed, one for the destitute and another for senior citizens. The Health Security approach guarantees the same quality care for everyone as a matter of right. Benefits: The program would have no exclusions for pre-existing conditions; no limits on preventive medical services; no coinsurance; no deductibles; no waiting periods. A-2 Physicians Services - Professional services by physicians, furnished in their offices or elsewhere, would be covered in full. This includes general medical and specialized services. All major surgery and other specialized care would be covered if performed by qualified specialists. Psychiatric services would be provided to outpatients if given for active treatment of emotional or mental disorders and if provided by comprehensive mental health organizations. Otherwise, there would be a limit of 20 consultations by a psychiatrist during a benefit period. Dental Services - At the start, Health Security dental benefits would be limited primarily to children up to age 15, with the coverage including preventive, diagnostic and therapeutic services. The age of eligibility for full dental care would be extended to persons up to age 25 during the first five years of the program's operation and the younger people would remain eligible throughout their lives. The increase of coverage could be accelerated if the Health Security Board believes it is feasible. Institutional Services Health Security would provide full payment for hospital services; skilled nursing home care up to 120 days per benefit period or for an unlimited time if the home is owned or managed by a hospital or provided by a health maintenance organization. The program would also include pathology and radiology services and all other necessary services whether furnished by a hospital or other institution or by others under arrangements with such institutions. A-3 Drugs: Health Security would cover drugs for hospital inpatients and outpatients and for persons enrolled in comprehensive group practice plans and professional foundations as long as the drugs were from an approved list. For others, drugs would be covered if they were necessary for specified chronic diseases and conditions requiring long or costly drug therapy. The purpose of the approved drug list would be to assure the safety, effectiveness and reasonable cost of the prescribed drugs. Other Professional and Supporting Services: Health Security would cover professional services of optometrists and podiatrists; diagnostic services of independent pathology laboratories; diagnostic and therapeutic services of independent radiologists; mental health day care services furnished by a health maintenance organization or comprehensive community health center, or 60 days of care furnished, during or following a benefit period, by a hospital or a center affiliated with a hospital; ambulance services; other professional services as psychological counseling, physiotherapy, nutrition, social work and home care or health education when furnished as part of institutional services or through health maintenance organizations; and diagnostic and therapeutic services of free-standing alcohol, drug abuse, family planning and rehabilitation centers. A-4 Social Care Services - Grants would be provided to local nonprofit organizations to develop social care services to aid chronically ill, aged and other homebound patients. Under this section, while some measure of local financing is developed, Health Security would cover homemaker services, transportation and other social care services as a demonstration of the usefulness of such benefits in reducing unnecessary National - Overall Health Security policy and regulation would be established and carried out by a five-member, full-time Health Security Board appointed by the President and under the supervision and direction of the Secretary of Health, Education and Welfare. The members normally would be appointed for five-year terms, with one member serving as chairman and with no more than three members from the same political party. The program would be administered through an Executive Director appointed by the Board. To assist the Board in carrying out its functions and to advise and recommend various changes or actions, a 21-member National Health Security Advisory Council would be established. A majority of the membership of the Council would be consumers of health services. The council would be authorized to appoint professional and technical committees to carry out its functions. The Secretary, Board and Executive Director would all work to assure effective coordination of Health Security with existing HEW programs and |