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United States National Health Care Act

The United States National Health Care Act or Expanded and Improved Medicare for All Act is a bill first introduced in the United States House of Representatives by former Representative John Conyers (D-MI) in 2003, with 25 cosponsors.[1][2] As of October 1, 2017, it had 120 cosponsors,[3] a majority of the Democratic caucus in the House of Representatives, and the highest level of support the bill has received since Conyers began annually introducing the bill in 2003.[4]

United States National Health Care Act
Great Seal of the United States
Long titleTo provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes.
Acronyms (colloquial)USNHCA/Single-Payer Health Care
Legislative history
  • Introduced in the House of Representatives as H.R. 676 by Rep. John Conyers (D-MI) on February 3, 2015
  • Committee consideration by Committee on Energy and Commerce, Committee on Ways and Means, Committee on Natural Resources

The act would establish a universal single-payer health care system in the United States, the rough equivalent of Canada's Medicare and Taiwan's Bureau of National Health Insurance, among other examples. Under a single-payer system, most medical care would be paid for by the federal government, ending the need for private health insurance and premiums, and probably recasting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought.

The national system would be paid for in part through taxes replacing insurance premiums, but also by savings realized through the provision of preventative universal healthcare and the elimination of insurance company overhead and hospital billing costs.[5] An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year.[6] Others have estimated a long-term savings amounting to 40% of all national health expenditures due to preventative health care.[7] Preventative care can save several hundreds of billions of dollars per year in the U.S., because for example cancer patients are more likely to be diagnosed at Stage I where curative treatment is typically a few outpatient visits, instead of at Stage III or later in an emergency room where treatment can involve years of hospitalization and is often terminal.[8]

During the 2009 health care debates over the bill that became the Patient Protection and Affordable Care Act, H.R. 676 was expected to be debated and voted upon by the House in September 2009,[9] but was never debated.[10]

On September 13, 2017, Senator Bernie Sanders introduced a parallel bill in the United States Senate with 16 cosponsors.[11][12][13] The act would establish a universal single-payer health care system in the United States.[5]

On January 22, 2019, the House passed HR 676, however, the bill under that number indicated Congressional support for NATO (unrelated to the subject of health care), necessitating a renumbering of the original 16 year old proposal.[14] In 2019, Pramila Jayapal (D-WA) charged with preparing a revised proposal in its place, introduced such a bill for the consideration of the 116th United States Congress.[15][16]



The summary of the National Health Care Act includes the following elements, among others:

  1. Expands the Medicare program to provide all individuals residing in the 50 states, Washington, DC, Puerto Rico, and territories of the United States with tax-funded health care that includes all medically necessary care. That would include primary and preventive care, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.
  2. Prohibits an institution from participating unless it is a public or nonprofit institution. Allows nonprofit health maintenance organizations (HMOs) that deliver care in their own facilities to participate. On the whole, private insurance would be replaced with the new nationalized system for all basic, major care.
  3. Gives patients the freedom to choose from participating physicians and institutions, which, given the coverage of the new national system, would be any institution or clinic in the United States receiving any degree of public funding (the vast majority).
  4. Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act. Allows the private insurers to sell benefits not medically necessary, such as cosmetic surgery benefits.
  5. Sets forth methods to pay institutional providers of care and health professionals for services. Prohibits financial incentives between HMOs and physicians based on utilization.
  6. Establishes the USNHC Trust Fund to finance the Program with amounts deposited: (1) from existing sources of government revenues for health care; (2) by increasing personal income taxes on the top 5% of income earners; (3) by instituting a progressive excise tax on payroll and self-employment income; and (4) by instituting a small tax on stock and bond transactions. Transfers and appropriates amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the State Children's Health Insurance Program. Taxes would be paid instead of insurance premiums, as the government (instead of private insurance companies) would be paying for the care under the single-payer health care.
  7. Establishes a program to assist individuals whose jobs are eliminated (such as within insurance companies) by the simplified single-payer administrative process.
  8. Requires creation of a confidential electronic patient record system.
  9. Establishes a National Board of Universal Quality and Access to provide advice on quality, access, and affordability.
  10. Provides for the eventual integration of the Indian Health Service into the Program and evaluation of the continued independence of Department of Veterans Affairs (VA) health programs.
  11. The bill covers treatments starting on the first day of the year that follows one year after the date of passage.
  12. Compensation continues for 15 years to owners of converting for-profit providers for reasonable financial losses.[17]


An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year.[6] Others have estimated a long-term savings amounting to 40% of all national health expenditures due the extended preventive healthcare and the elimination of insurance company overhead costs.[7]

A study by Harvard University and the Canadian Institute for Health Information estimated the 1999 costs of U.S. health care administration at nearly $300 billion, accounting for 30.1% of health care expenses, versus 16.7% in Canada. This study estimated the U.S. per-person administrative cost at $1,059.[18]

Senate billEdit

On 13 September 2017, in the aftermath of his 2016 presidential campaign in which single-payer healthcare was among the core tenets of his platform, Sen. Bernie Sanders introduced the "Medicare-for-all Act of 2017" S. 1804],[19] a parallel bill to the "United States National Health Care Act" (H.R. 676) that was introduced by Rep. John Conyers in the House.[1][19]

Notably, Sanders had introduced a similar version of the bill in 2013, but no other Senators cosponsored it. This time, his 2017 version attracted sixteen Democratic cosponsors besides himself:[20][21]

Sanders explains the rationale for the bill in terms of per-capita healthcare costs in the United States compared to other countries:[22]

Despite so many uninsured and under-insured, the United States spends far more per capita on health care than any other nation. According to the OECD, in 2015, the U.S. spent almost $10,000 per person for health care, while the Canadians spent $4,644, the Germans $5,551, the French $4,600, and the British $4,192 even though all of these other countries guarantee health care to all of their people. Despite this huge expenditure, life expectancy in America is lower than most other industrialized countries and our infant mortality rates are much higher.

— Bernie Sanders, Press Release, September 13, 2017

He argues that the universal healthcare systems in other countries are responsible for their decreased costs and urges that the United States follow suit.

In 2019 Bernie Sanders introduced the Medicare for All Act of 2019.[23] According to Robert Moffit, per section 303 of the legislation, if any doctor provides any private service outside of the government plan, the doctor may not bill the government for any service for any reason for one year.[24] Sanders proposed new taxes to pay for Medicare for All, including progressive taxes on workers.[25]

See alsoEdit


  1. ^ a b H.R. 676
  2. ^ "House Reps Introduce Medicare-for-All Bill" Becker's Hospital Review, Feb. 14, 2013
  3. ^ "H.R.676 - Expanded & Improved Medicare For All Act". U.S. Congress. Retrieved August 12, 2017.
  4. ^ Sullivan, Peter (May 24, 2017). "Dem lawmakers call for single-payer healthcare". The Hill. Retrieved May 24, 2017.
  5. ^ a b Krugman, Paul (June 13, 2005). "One Nation, Uninsured". The New York Times. Retrieved December 4, 2011.
  6. ^ a b Physicians for a National Health Program (2008) "Single Payer System Cost?" Archived December 6, 2010, at the Wayback Machine
  7. ^ a b Hogg, W.; Baskerville, N; Lemelin, J (2005). "Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis". BMC Health Services Research. 5 (1): 20. doi:10.1186/1472-6963-5-20. PMC 1079830. PMID 15755330.
  8. ^ Adrian R. Levy; Craig Mitton; Karissa M. Johnston; Brian Harrigan; Andrew H. Briggs; et al. (October 2010). "International comparison of comparative effectiveness research in five jurisdictions: insights for the US". PharmacoEconomics. 28 (10): 813–30. doi:10.2165/11536150-000000000-00000. PMID 20831289.
  9. ^ "Single Payer Gets A Vote (Updated)". New York Daily News. July 31, 2009. Archived from the original on September 4, 2009. Retrieved September 12, 2009.
  10. ^ "H.R. 676: United States National Health Care Act or the Expanded and Improved Medicare for All Act (". Retrieved December 1, 2009.
  11. ^ "Bernie Sanders to Sponsor Single-Payer Healthcare Bill". Newsweek. March 26, 2017.
  12. ^ RoseAnn DeMoro [@RoseAnnDeMoro] (September 13, 2017). ".@BernieSanders shouts out the Democrats that did the right thing in supporting #MedicareForAll. #WednesdayWisdom" (Tweet). Retrieved September 13, 2017 – via Twitter.
  13. ^ "115th United States Congress". U.S. Congress. 2017–2018.
  14. ^
  15. ^
  16. ^ Klein, Ezra. "Pramila Jayapal Thinks We Can Get to Medicare-for-all Fast". Archived from the original on February 28, 2019. Retrieved March 4, 2019.
  17. ^ "United States National Health Care Act – Summary". U.S. Congress. Retrieved December 4, 2011.
  18. ^ "Research Report-Harvard & Canadian Institute for Health Information-Costs of Healthcare Administration in the U.S. and Canada 2003" (PDF). Retrieved December 4, 2011.
  19. ^ a b Bernie Sanders (September 13, 2017). "S.1804 - Medicare for All Act of 2017". U.S. Congress.
  20. ^ Foran, Clare. "Bernie Sanders Makes His Pitch for Single Payer". The Atlantic. Retrieved September 26, 2017.
  21. ^ Park, Haeyoun; Andrews, Wilson (September 13, 2017). "One-Third of Democratic Senators Support Bernie Sanders's Single-Payer Plan". The New York Times. Retrieved September 26, 2017.
  22. ^ Sen. Bernie Sanders. "17 Senators Introduce Medicare for All Act". Retrieved September 26, 2017.
  23. ^ Bernie Sanders. "To establish a Medicare-for-all national health insurance program".
  24. ^ Robert Moffit (April 11, 2019). "New 'Medicare for All' Bill Would Kick 181 Million Off Private Insurance". The Daily Signal. Retrieved April 12, 2019. Doctors who choose to take private payment from patients outside the system would face a stiff penalty. Under Section 303, the physician would have to sign an affidavit that he engaged in such a contract, submit it to the secretary of health and human services, and then forego all reimbursement from all other patients enrolled in the new federal entitlement for a period of one year. Few doctors, of course, would be able to do such a thing.
  25. ^ Nicholas Sakelaris; Danielle Haynes (April 10, 2019). "Bernie Sanders introduces 'Medicare For All' universal healthcare plan". United Press International. Retrieved April 12, 2019. Sen. Sanders issued a document Wednesday proposing ways to cover costs, including progressive taxes on American workers, more taxes for the wealthy and fees for large financial institutions.

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