A BILL
To establish a universal, comprehensive, publicly-funded healthcare system to ensure healthcare coverage for all persons in the United States.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “American Health Care Freedom Act”.
Back to Table of ContentsSECTION 2. PURPOSE AND ESTABLISHMENT OF THE NATIONAL HEALTH PROGRAM.
(a) IN GENERAL.—There is hereby established a national health insurance program to be known as the “National Health Care Program” (in this Act referred to as the “NHCP”) to provide comprehensive health insurance coverage to all residents of the United States.
(b) ADMINISTRATION.—The NHCP shall be administered by the Centers for Medicare & Medicaid Services (in this Act referred to as “CMS”) under the supervision of the Secretary of Health and Human Services (in this Act referred to as the “Secretary”).
(c) PURPOSE.—The purpose of this Act is to ensure that all residents of the United States have access to all necessary medical care, including preventive, primary, specialty, emergency, hospital, and long-term care services regardless of income, employment, or health status.
Back to Table of ContentsSECTION 3. DEFINITIONS.
In this Act:
(a) “NHCP” means the National Health Care Program established under Section 2 of this Act.
(b) “Secretary” means the Secretary of Health and Human Services.
(c) “CMS” means the Centers for Medicare & Medicaid Services.
(d) “Healthcare provider” means a physician, nurse, nurse practitioner, physician assistant, midwife, psychologist, social worker, pharmacist, physical therapist, occupational therapist, dentist, optometrist, audiologist, or other health professional licensed or certified to provide healthcare services to individuals.
(e) “Healthcare facility” means a hospital, outpatient clinic, community health center, rural health clinic, skilled nursing facility, rehabilitation center, birthing center, or other facility where healthcare services are provided.
(f) “Resident of the United States” means an individual who is lawfully present in the United States and: (1) Is a citizen or national of the United States; (2) Is a lawful permanent resident; (3) Has been granted asylum, refugee status, or other lawful immigration status; or (4) Otherwise meets residency criteria established by the Secretary through regulation.
(g) “Medically necessary care” means healthcare services or products that a healthcare provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, diagnosing, treating, or rehabilitating an illness, injury, disease, or its symptoms, and that are: (1) In accordance with generally accepted standards of medical practice; (2) Clinically appropriate, in terms of type, frequency, extent, site, and duration; (3) Not primarily for the economic benefit of health insurance plans or healthcare providers or for the convenience of the patient, healthcare provider, or health insurance plan; and (4) Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results.
(h) “Gender-affirming care” means a range of social, psychological, behavioral, and medical interventions designed to support and affirm an individual’s gender identity when it conflicts with the gender they were assigned at birth, including but not limited to social affirmation, puberty blockers, hormone therapy, and surgical interventions.
(i) “Reproductive healthcare services” means healthcare, services, and information related to the reproductive system and its functions, including services related to contraception, fertility, pregnancy, childbirth, abortion, and reproductive health.
(j) “Health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract.
(k) “Long-term care services and supports” means a range of services and supports that help meet both the medical and non-medical needs of people with chronic illnesses or disabilities who cannot care for themselves for extended periods, including assistance with activities of daily living and instrumental activities of daily living.
(l) “Regulated health innovation industry” means the classification of pharmaceutical companies and medical technology developers established under Section 20 of this Act.
(m) “Federal poverty level” means the poverty guidelines updated periodically in the Federal Register by the Department of Health and Human Services under the authority of 42 U.S.C. 9902(2).
(n) “National Health Advisory Board” means the advisory board established under Section 6(c) of this Act.
(o) “Federal Malpractice Compensation Fund” means the fund established under Section 17(b) of this Act.
(p) “Early childhood education” means educational programs and services for children from birth through age five, designed to foster cognitive and social development before elementary school.
(q) “Afterschool care” means programs that provide supervision and enrichment activities for school-age children during non-school hours.
Back to Table of ContentsSECTION 4. ELIGIBILITY AND ENROLLMENT.
(a) IN GENERAL.—Every individual who is a resident of the United States is entitled to benefits for healthcare services under the NHCP. The Secretary shall promulgate rules that establish criteria for determining residency for eligibility purposes under this Act.
(b) AUTOMATIC ENROLLMENT.—
(1) All individuals who are residents of the United States shall be automatically enrolled in the NHCP.
(2) Coverage under the NHCP shall begin: (A) At birth for individuals born in the United States; or (B) Upon establishing residency for individuals entering the United States.
(c) IDENTIFICATION CARDS.—The Secretary shall provide for the issuance of a National Health Care Program Card to each individual enrolled under the NHCP. Such card shall be used for purposes of identification and processing of claims for benefits under the NHCP.
Back to Table of ContentsSECTION 5. COVERED BENEFITS.
(a) IN GENERAL.—Under the NHCP, every individual who is a resident of the United States is entitled to benefits for healthcare services. The Secretary shall determine the covered benefits under this section.
(b) COVERED SERVICES.—Such benefits shall include at least the following services furnished by a healthcare provider:
(1) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services;
(2) Professional services of healthcare practitioners authorized to provide healthcare services under State law;
(3) Primary care and preventive services, including but not limited to: (A) Evidence-based screenings recommended by the United States Preventive Services Task Force; (B) Regular health assessments and risk factor evaluations for all age groups; (C) Immunizations recommended by the Advisory Committee on Immunization Practices; (D) Preventive services recommended by the Health Resources and Services Administration for women and children; (E) Routine dental cleanings and preventive oral healthcare; (F) Vision and hearing screenings; (G) Counseling and education for disease prevention and health promotion; and (H) Early detection services for conditions where early intervention improves outcomes;
(4) Prescription drugs, medical devices, biological products, including outpatient prescription drugs, medical devices, and biological products;
(5) Mental health and substance use treatment services, including inpatient care;
(6) Laboratory and diagnostic services;
(7) Comprehensive reproductive, maternity, and newborn care, including but not limited to: (A) Abortion services; (B) Contraceptive services and supplies; (C) Family planning services; (D) Fertility services; and (E) All other reproductive healthcare services;
(8) Gender-affirming care, including but not limited to: (A) Hormone therapy; (B) Mental health services; (C) Voice therapy; (D) Surgical procedures; and (E) All other gender-affirming healthcare services;
(9) Pediatric services including early and periodic screening, diagnostic, and treatment services (as defined in section 1905(r) of the Social Security Act);
(10) Dental services, hearing services, and vision services;
(11) Rehabilitative and habilitative services and devices;
(12) Emergency services and transportation, including ambulance services contracted by the Federal Government;
(13) Home and community-based long-term care services and supports;
(14) Hospice care and end-of-life care services; and
(15) Any additional healthcare services deemed medically necessary or appropriate by the Secretary.
(c) EXCLUSIONS.—
(1) IN GENERAL.—Benefits provided under this section shall not include elective procedures that are purely cosmetic in nature and not medically necessary.
(2) EXCEPTIONS.—The exclusion in paragraph (1) shall not apply to procedures that are prescribed for mental health reasons or for reconstructive purposes as determined by the Secretary.
(d) MEDICALLY NECESSARY CARE.—
(1) For purposes of this Act, the following shall be explicitly recognized as medically necessary care: (A) All gender-affirming care as specified in subsection (b)(8); (B) All reproductive care, including abortion and contraceptive services as specified in subsection (b)(7); and (C) Any other services deemed medically necessary by the Secretary.
(e) PREVENTIVE CARE PRIORITIES AND STANDARDS.—
(1) PRIORITY FOCUS AREAS.—The Secretary shall establish and regularly update national preventive healthcare priorities, which shall include, at minimum: (A) Reduction of chronic disease burden through early intervention and lifestyle modification programs; (B) Maternal and child health improvement, including prenatal and postnatal care; (C) Prevention of infectious diseases through comprehensive vaccination programs; (D) Behavioral and mental health screening and early intervention; (E) Health equity advancement by addressing social determinants of health; and (F) Environmental health risk reduction.
(2) EVIDENCE-BASED STANDARDS.—The Secretary shall: (A) Adopt evidence-based preventive care guidelines developed by recognized medical and public health authorities; (B) Regularly update these guidelines based on emerging research and clinical evidence; (C) Establish metrics to evaluate the effectiveness of preventive services; and (D) Ensure that preventive care services meet or exceed internationally recognized standards.
(3) COVERAGE MANDATE.—All preventive services assigned an “A” or “B” rating by the United States Preventive Services Task Force must be covered without cost-sharing or utilization management restrictions.
(4) INNOVATIVE PREVENTION PROGRAMS.—The Secretary shall establish grant programs to develop, test, and implement innovative approaches to preventive care delivery, including: (A) Community-based prevention initiatives; (B) Workplace wellness programs; (C) School-based health promotion activities; (D) Technology-enabled prevention services; and (E) Interdisciplinary collaborative models incorporating clinical and community-based prevention.
Back to Table of ContentsSECTION 6. EARLY CHILDHOOD AND AFTERSCHOOL CARE PROGRAMS.
(a) ESTABLISHMENT.—The Secretary shall establish a national program for early childhood education and afterschool care services that is:
(1) Available to all children from birth through age 12; (2) Provided at no cost to families with household incomes below 400 percent of the Federal poverty level; and (3) Available on a sliding scale fee basis for families with higher incomes.
(b) PROGRAM REQUIREMENTS.—
(1) EARLY CHILDHOOD EDUCATION.—The early childhood education component of the program shall: (A) Provide full-day, developmentally appropriate care and education for children from birth to kindergarten entry; (B) Meet or exceed evidence-based quality standards as established by the Secretary; (C) Be staffed by qualified early childhood educators receiving compensation comparable to elementary school teachers with similar credentials; and (D) Implement curriculum aligned with state early learning standards.
(2) AFTERSCHOOL CARE.—The afterschool care component of the program shall: (A) Provide supervision and enrichment activities for school-age children up to age 12; (B) Operate during non-school hours, including before school, after school, during school holidays, and during summer breaks; (C) Include educational support, physical activity, arts programming, and nutritional components; and (D) Be staffed by qualified childcare providers and educators receiving professional wages and benefits.
(c) PROVIDER PARTICIPATION.—
(1) CONTRACTED SERVICES.—The Secretary shall enter into contracts with qualified childcare providers, public schools, community organizations, and other entities to provide early childhood and afterschool care services under this section.
(2) RATES.—Participating providers may bill the Federal Government at rates established by the Secretary, which shall: (A) Reflect the true cost of providing high-quality care; (B) Include adequate compensation for staff; (C) Account for regional cost variations; and (D) Be adjusted annually for inflation.
(3) QUALITY STANDARDS.—All participating providers shall: (A) Meet rigorous quality standards established by the Secretary in consultation with early childhood experts; (B) Maintain appropriate child-to-staff ratios based on children’s ages; (C) Implement developmentally appropriate curricula and practices; (D) Provide safe, healthy, and stimulating environments; (E) Employ staff with appropriate education and credentials; and (F) Participate in ongoing quality improvement initiatives.
(4) RELIGIOUS ORGANIZATION PARTICIPATION— (A) ELIGIBILITY.—Religious organizations shall be eligible to participate as providers of early childhood education and afterschool care services under this section, provided they meet all quality standards and other requirements established by the Secretary. (B) PROHIBITION ON MANDATORY RELIGIOUS ACTIVITIES.—Programs offered by religious organizations and funded under this section: (i) Shall not include religious instruction, worship, prayer, or proselytization as part of the services provided unless a child’s parent or legal guardian has provided express written consent for their child to participate in such activities; (ii) Shall provide all core educational and care services in a secular manner; (iii) Shall not require religious-based admission criteria for children to participate in the publicly funded program; and (iv) Shall not discriminate in employment for positions whose duties are solely related to the secular aspects of the program. (C) RELIGIOUS ACTIVITIES SEPARATION.—Any religious activities offered by providers must be: (i) Clearly separated from the secular early childhood education and afterschool care services funded under this section; (ii) Optional and provided only with express written parental consent; (iii) Offered at times that do not interfere with the delivery of core educational services; and (iv) Funded separately without the use of funds provided under this section. (D) PARENTAL NOTICE.—Religious organizations shall provide clear written notice to parents regarding: (i) The religious character of the organization; (ii) The voluntary nature of any religious activities; (iii) The procedure for providing or withdrawing consent for participation in religious activities; and (iv) Assurance that a child’s participation or non-participation in religious activities will not affect their access to core services provided under this section.
(d) IMPLEMENTATION.—
(1) PHASED ROLLOUT.—The Secretary shall implement the program in phases: (A) PHASE 1 (MONTHS 1-12)—Planning, development of standards, and initial provider recruitment; (B) PHASE 2 (MONTHS 13-24)—Enrollment of children from families with incomes below 200 percent of the Federal poverty level and expansion of provider network; and (C) PHASE 3 (MONTHS 25-36)—Expansion to all eligible children and full implementation.
(2) COORDINATION.—The Secretary shall coordinate implementation with the Secretary of Education and relevant state agencies to ensure alignment with existing early childhood and education systems.
(e) WORKFORCE DEVELOPMENT.—
(1) CAREER PATHWAYS.—The Secretary, in coordination with the Secretary of Education and the Secretary of Labor, shall establish career pathways for early childhood and afterschool care professionals.
(2) COMPENSATION.— (A) Participating providers shall compensate staff at levels comparable to public school teachers with similar credentials and experience. (B) The Secretary shall establish minimum wage requirements for different staff positions based on credentials, experience, and responsibilities.
(3) EDUCATION AND TRAINING.—The program shall include funding for: (A) Scholarships for early childhood education and related degrees; (B) Professional development opportunities; (C) Apprenticeship programs; and (D) Training and technical assistance for providers.
(f) REPORTING AND EVALUATION.—
(1) PROVIDER REPORTING.—Participating providers shall submit annual reports to the Secretary on: (A) Enrollment demographics; (B) Program quality measures; (C) Staff qualifications and turnover; (D) Child outcomes; and (E) Financial information.
(2) PROGRAM EVALUATION.—The Secretary shall: (A) Conduct regular evaluations of program effectiveness; (B) Track child development outcomes; (C) Assess cost-effectiveness; and (D) Submit an annual report to Congress on program performance.
Back to Table of ContentsSECTION 7. HEALTH SYSTEM ADMINISTRATION.
(a) ESTABLISHMENT OF DIVISION.—There is established within CMS a division to be known as the “National Health Care Program Division” to oversee the implementation of the NHCP.
(b) STAFFING.—The National Health Care Program Division shall be staffed with:
(1) Program administrators; (2) Data analysts; (3) Claims processors; (4) Customer support specialists; and (5) Such other personnel as the Secretary determines necessary.
(c) NATIONAL HEALTH ADVISORY BOARD.—
(1) ESTABLISHMENT.—There is established an independent National Health Advisory Board to oversee the performance of the NHCP and make recommendations for improvements.
(2) COMPOSITION.—The Board shall be composed of 15 members appointed by the President with the advice and consent of the Senate, including: (A) Healthcare providers; (B) Patient advocates; (C) Public health experts; (D) Healthcare economists; and (E) Representatives of the general public.
(3) DUTIES.—The Board shall: (A) Monitor the performance of the NHCP; (B) Identify areas for improvement; (C) Recommend updates to covered benefits; (D) Submit annual reports to Congress on the state of the NHCP; and (E) Perform such other duties as the Secretary may prescribe.
Back to Table of ContentsSECTION 8. REGULATORY OVERSIGHT AND ADMINISTRATION.
(a) DEPARTMENTAL RESPONSIBILITIES.—
(1) DEPARTMENT OF HEALTH AND HUMAN SERVICES.— (A) Overall administration of the NHCP; (B) Implementation of enrollment systems; (C) Establishment and oversight of provider standards; (D) Development of quality metrics and performance standards; (E) Administration of the Federal Malpractice Compensation Fund; and (F) Coordination with other federal agencies.
(2) CENTERS FOR MEDICARE & MEDICAID SERVICES.— (A) Day-to-day operation of the NHCP; (B) Processing of healthcare claims; (C) Provider payment administration; (D) Data collection and analysis; (E) Quality assurance monitoring; and (F) Customer service and patient advocacy.
(3) FOOD AND DRUG ADMINISTRATION.— (A) Continued regulation of pharmaceuticals, medical devices, and biologics; (B) Collaboration with CMS on drug pricing negotiations; and (C) Expedited review of critical medications and medical technologies.
(4) CENTERS FOR DISEASE CONTROL AND PREVENTION.— (A) Public health surveillance and monitoring; (B) Health promotion and disease prevention programs; (C) Emergency preparedness coordination; and (D) Health disparities monitoring and intervention.
(5) HEALTH RESOURCES AND SERVICES ADMINISTRATION.— (A) Healthcare workforce development; (B) Health professional education programs; (C) Rural healthcare initiatives; and (D) Healthcare facility infrastructure projects.
(6) SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION.— (A) Mental health and substance use disorder program development; (B) Provider training for behavioral health services; and (C) Integration of behavioral health services within the NHCP.
(7) NATIONAL INSTITUTES OF HEALTH.— (A) Biomedical research coordination with the regulated health innovation industry; (B) Clinical trial oversight; and (C) Translation of research advances into clinical practice.
(b) REGULATORY COORDINATION.—
(1) INTERAGENCY COORDINATING COUNCIL.—There is established an Interagency Coordinating Council for Healthcare, comprised of representatives from all agencies listed in subsection (a), to: (A) Ensure collaboration across federal agencies; (B) Prevent regulatory duplication and conflicts; (C) Coordinate implementation activities; and (D) Address emerging healthcare issues requiring multi-agency response.
(2) STATE COORDINATION.—The Secretary shall establish mechanisms for coordination with State health departments and agencies to: (A) Align public health initiatives; (B) Integrate state healthcare programs and resources; and (C) Ensure compliance with federal standards while respecting local health priorities.
(c) PROGRAM INTEGRITY.—
(1) INSPECTOR GENERAL OFFICE.—There is established within the Department of Health and Human Services an Office of the Inspector General for the NHCP to: (A) Prevent and detect fraud, waste, and abuse; (B) Conduct audits and investigations; (C) Recommend program improvements; and (D) Issue semiannual reports to Congress on program integrity.
(2) COMPTROLLER GENERAL OVERSIGHT.—The Comptroller General of the United States shall conduct periodic reviews of the NHCP and report findings to Congress.
Back to Table of ContentsSECTION 9. PERFORMANCE OVERSIGHT.
(a) QUALITY ASSURANCE BOARD.—
(1) ESTABLISHMENT.—There is established within CMS a Quality Assurance Board to monitor the performance of healthcare providers under the NHCP.
(2) DUTIES.—The Board shall: (A) Monitor performance metrics of healthcare providers; (B) Administer continuing education, re-certification, and professional development programs; (C) Identify underperforming healthcare providers; and (D) Develop and implement improvement plans focused on support rather than punitive measures.
Back to Table of ContentsSECTION 10. PRIVACY PROTECTIONS AND DATA SECURITY.
(a) PRIVACY OF HEALTH INFORMATION.—
(1) PROHIBITION ON SHARING.—The NHCP, its employees, agents, and contractors are expressly prohibited from sharing any identifiable patient health information, medical records, or healthcare data with: (A) Any other federal agency, department, or entity not directly involved in the patient’s care or the administration of benefits for that specific patient; (B) Any state or local government entity; (C) Any private entity not directly involved in the patient’s care; or (D) Any other individual who is not: (i) The patient; (ii) A healthcare provider directly involved in the patient’s care; (iii) A person with written authorization from the patient to receive such information; or (iv) A personal representative legally authorized to act on the patient’s behalf.
(2) RESTRICTIONS ON LAW ENFORCEMENT ACCESS.— (A) No patient health information, medical records, or healthcare data may be provided to any law enforcement agency without: (i) A warrant issued by a court of competent jurisdiction based on probable cause; or (ii) A court order that specifically identifies the information sought and demonstrates that: (I) The information sought is relevant and material to a legitimate law enforcement inquiry; (II) The request is as specific and narrowly drawn as reasonably possible; and (III) De-identified information could not reasonably be used. (B) Any information provided pursuant to subparagraph (A) shall be limited to the minimum necessary to fulfill the legal purpose of the request. (C) Notice shall be provided to the patient prior to the release of any information unless a court determines that notice would impede a legitimate law enforcement purpose.
(3) INFORMATION RELATED TO REPRODUCTIVE HEALTH OR GENDER-AFFIRMING CARE.— (A) Notwithstanding paragraph (2), information related to reproductive health services, including but not limited to abortion, contraception, or fertility treatments, or information related to gender-affirming care, shall not be disclosed to any law enforcement agency for the purpose of investigating or prosecuting any person for seeking, providing, or assisting with such services. (B) In states where reproductive healthcare or gender-affirming care is criminalized, the NHCP shall implement additional safeguards to protect the privacy of individuals receiving such care.
(4) EXCEPTIONS.— (A) PUBLIC HEALTH.—De-identified or aggregated information may be shared for legitimate public health purposes, including disease surveillance, outbreak investigation, and research. (B) REQUIRED BY LAW.—Disclosures specifically required by federal law, provided that: (i) Only the minimum necessary information is disclosed; and (ii) The patient is notified of the disclosure when practicable. (C) THREAT TO HEALTH OR SAFETY.—Disclosures necessary to prevent or lessen a serious and imminent threat to the health or safety of the patient or the public.
(b) DATA SECURITY.—
(1) SECURITY STANDARDS.—The Secretary shall establish and maintain rigorous security standards for all NHCP data systems that, at minimum: (A) Implement state-of-the-art encryption for data at rest and in transit using FIPS 140-3 validated encryption or higher standards as they evolve; (B) Require multi-factor authentication for all system access with risk-based authentication protocols for different access levels; (C) Maintain comprehensive audit trails for all data access and transfers with immutable logs retained for not less than seven years; (D) Segment data systems to limit access to the minimum necessary information based on role-based access controls and the principle of least privilege; (E) Conduct regular security assessments and penetration testing on no less than a quarterly basis by both internal teams and independent third-party security firms; (F) Implement immediate security updates when vulnerabilities are identified with critical vulnerabilities remediated within 72 hours; (G) Establish a comprehensive Security Operations Center (SOC) with 24/7 monitoring capabilities to detect and respond to potential security incidents in real-time; (H) Implement a zero-trust architecture framework that assumes no user or system is inherently trusted; (I) Develop a comprehensive incident response plan that is tested through tabletop exercises quarterly and full-scale simulations annually; and (J) Maintain a regularly updated inventory of all hardware and software assets with automated tools to detect unauthorized changes.
(2) CYBERSECURITY IMPLEMENTATION FRAMEWORK.— (A) BASELINE FRAMEWORK.—The Secretary shall adopt the National Institute of Standards and Technology (NIST) Cybersecurity Framework as the baseline for all NHCP information systems, supplemented by healthcare-specific controls from the NIST Special Publication 800-66. (B) IMPLEMENTATION TIERS.—The Secretary shall designate each NHCP information system component according to criticality and sensitivity, with corresponding security requirements: (i) TIER 1 (CRITICAL).—Systems containing sensitive patient information or supporting critical healthcare functions shall implement all security controls at the highest maturity level with no exceptions or waivers. (ii) TIER 2 (HIGH).—Systems supporting important but non-critical functions shall implement all required controls with limited, time-bounded waivers permitted only with explicit CISO approval. (iii) TIER 3 (MODERATE).—Administrative systems shall implement baseline security controls appropriate to sensitivity level as determined by the NHCP Chief Information Security Officer. (C) SECURITY ARCHITECTURE REVIEWS.—All new information systems or significant modifications shall undergo security architecture reviews before deployment, with sign-off required from: (i) The NHCP Chief Information Security Officer; (ii) The NHCP Chief Privacy Officer; and (iii) An independent third-party security assessor. (D) CONTINUOUS MONITORING.—The Secretary shall implement a continuous diagnostics and mitigation program that includes: (i) Real-time vulnerability scanning and remediation tracking; (ii) Behavioral analytics to detect anomalous user or system activities; (iii) Automated compliance monitoring for all security controls; and (iv) Integration with a threat intelligence platform to identify emerging threats.
(3) CYBERSECURITY WORKFORCE.— (A) STAFFING REQUIREMENTS.—The Secretary shall establish minimum staffing requirements for cybersecurity personnel, with a ratio of not less than one qualified security professional per 1,000 system users. (B) QUALIFICATIONS.—All cybersecurity staff shall maintain relevant professional certifications appropriate to their roles, including but not limited to CISSP, CISM, CEH, or comparable credentials. (C) TRAINING.—All NHCP information technology staff shall complete a minimum of 40 hours of security training annually, with specialized training requirements for security personnel. (D) SECURITY CLEARANCES.—Senior cybersecurity personnel shall maintain appropriate federal security clearances to enable threat intelligence sharing with federal agencies.
(4) SUPPLY CHAIN SECURITY.— (A) VENDOR ASSESSMENT.—The Secretary shall establish a rigorous vendor risk assessment process for all technology providers, including: (i) Security questionnaires aligned with NIST 800-161; (ii) Independent security assessments for critical vendors; (iii) Code reviews for custom software; and (iv) Continuous monitoring of vendor security postures. (B) SECURE DEVELOPMENT.—All software developed for or implemented in NHCP systems shall follow secure software development lifecycle practices, including: (i) Threat modeling during design phase; (ii) Static and dynamic application security testing; (iii) Software composition analysis for third-party components; and (iv) Regular security code reviews. (C) HARDWARE VERIFICATION.—Critical infrastructure components shall undergo hardware verification to detect unauthorized modifications or implants before deployment.
(2) BREACH NOTIFICATION AND RESPONSE.— (A) In the event of a data breach or unauthorized access to patient information, the Secretary shall: (i) Notify affected individuals within 72 hours of discovery; (ii) Provide comprehensive identity theft protection services to affected individuals for a period of not less than five years; (iii) Conduct a thorough investigation of the breach, including root cause analysis; (iv) Report remediation steps to Congress within 30 days of the breach; and (v) Publish an anonymized public report detailing the nature of the breach and lessons learned. (B) BREACH RESPONSE TEAM.—The Secretary shall establish a dedicated breach response team composed of: (i) Cybersecurity specialists; (ii) Legal and compliance officers; (iii) Communications experts; (iv) Patient advocates; and (v) Executive leadership representatives. (C) RECOVERY REQUIREMENTS.—Following any security incident, the Secretary shall ensure: (i) All affected systems are restored to secure operations within recovery time objectives established for each system tier; (ii) All compromised credentials are revoked and reset; (iii) A comprehensive post-incident review is conducted with recommendations to prevent similar incidents; and (iv) All recommendations are tracked to implementation with quarterly status reports to the Privacy Oversight Board.
(c) PENALTIES FOR VIOLATIONS.—
(1) INDIVIDUAL PENALTIES.— (A) Any individual who knowingly accesses, uses, or discloses patient information in violation of this section shall be: (i) Subject to immediate termination of employment or contract with the NHCP; (ii) Personally liable for civil damages of not less than $50,000 per violation; (iii) Subject to criminal penalties including a fine under title 18, United States Code, of up to $250,000, imprisonment for up to 10 years, or both for intentional violations; and (iv) Permanently barred from future employment with the NHCP or any federal healthcare program.
(2) ENTITY PENALTIES.— (A) Any entity that facilitates or fails to prevent the unauthorized access, use, or disclosure of patient information shall be: (i) Subject to a civil penalty of not less than $100,000 per violation; (ii) Subject to contract termination if applicable; and (iii) Required to implement comprehensive corrective action plans.
(3) ENHANCED PENALTIES.— (A) Enhanced penalties of up to three times the amounts specified in paragraphs (1) and (2) shall apply to violations: (i) Involving multiple patients; (ii) For commercial advantage, personal gain, or malicious harm; (iii) Involving reproductive health or gender-affirming care information; or (iv) That result in discrimination, harassment, or harm to the patient.
(d) PATIENT RIGHTS.—
(1) RIGHT OF ACCESS.—Patients shall have the right to: (A) Access their complete medical records in electronic format without charge; (B) Request corrections to inaccurate information; (C) Receive an accounting of all disclosures of their information; and (D) Opt out of research and data aggregation programs.
(2) PRIVATE RIGHT OF ACTION.— (A) Any patient whose privacy rights under this section have been violated may bring a civil action in an appropriate United States district court. (B) RELIEF.—In a successful action under this paragraph, the court may award: (i) Actual damages; (ii) Statutory damages of not less than $50,000 per violation; (iii) Punitive damages for willful or reckless violations; (iv) Reasonable attorney’s fees and costs; and (v) Appropriate injunctive relief.
(e) PRIVACY OVERSIGHT BOARD.—
(1) ESTABLISHMENT.—There is established within the NHCP an independent Privacy Oversight Board to: (A) Monitor compliance with privacy requirements; (B) Investigate potential violations; (C) Recommend privacy policy improvements; (D) Review data-sharing protocols; and (E) Report annually to Congress on privacy protection effectiveness.
(2) COMPOSITION.—The Board shall be composed of 9 members, including: (A) Privacy and civil liberties experts; (B) Healthcare providers; (C) Patient advocates; (D) Technology and security experts; and (E) At least one member with expertise in reproductive healthcare and gender-affirming care.
(3) CYBERSECURITY GOVERNANCE.— (A) CHIEF INFORMATION SECURITY OFFICER.—The Secretary shall appoint a Chief Information Security Officer (CISO) for the NHCP who shall: (i) Report directly to the Secretary; (ii) Have authority to mandate security measures across all NHCP systems; (iii) Lead the development and implementation of the NHCP cybersecurity strategy; and (iv) Serve as a non-voting advisor to the Privacy Oversight Board. (B) EXECUTIVE CYBERSECURITY COUNCIL.—There is established an Executive Cybersecurity Council that shall: (i) Be co-chaired by the CISO and a designated member of the Privacy Oversight Board; (ii) Include representation from all major NHCP divisions and relevant HHS agencies; (iii) Review and approve all major cybersecurity policies and investments; (iv) Meet at least monthly to review security status and emerging threats; and (v) Report quarterly to the Secretary and the Privacy Oversight Board. (C) INDEPENDENT SECURITY ASSESSMENTS.—The Privacy Oversight Board shall commission annual independent security assessments of NHCP systems, with results reported directly to Congress.
(4) COMPLIANCE AND CERTIFICATION.— (A) MANDATORY STANDARDS.—All NHCP information systems shall comply with: (i) NIST Special Publication 800-53 security controls at the HIGH baseline; (ii) HIPAA Security Rule requirements; (iii) Federal Risk and Authorization Management Program (FedRAMP) standards for cloud systems; and (iv) Any additional security requirements established by the Secretary. (B) CERTIFICATION AND ACCREDITATION.—All NHCP information systems shall undergo formal certification and accreditation before operation and re-authorization at least every three years. (C) CONTINUOUS COMPLIANCE MONITORING.—The CISO shall implement automated tools to continuously monitor compliance with security standards and immediately address deviations. (D) ANNUAL CERTIFICATIONS.—The CISO and system owners shall jointly certify in writing to the Privacy Oversight Board and to Congress that systems meet all security requirements.
Back to Table of ContentsSECTION 11. ETHICS PROVISIONS AND CONFLICTS OF INTEREST.
(a) POST-EMPLOYMENT LOBBYING RESTRICTIONS.—
(1) MORATORIUM.—Any individual who has been employed by or served as an officer, director, or contractor for the NHCP shall be prohibited from engaging in lobbying activities related to healthcare policy, regulation, or funding for a period of 10 years after the termination of such employment or service.
(2) DEFINITION OF LOBBYING ACTIVITIES.—For purposes of this section, the term “lobbying activities” means: (A) Lobbying contacts and efforts in support of such contacts, including preparation and planning activities, research, and other background work intended for use in such contacts; and (B) Any oral, written, or electronic communication to a covered executive branch official or a covered legislative branch official that is made on behalf of a client with regard to: (i) The formulation, modification, or adoption of Federal legislation; (ii) The formulation, modification, or adoption of a Federal rule, regulation, Executive order, policy, or program; (iii) The administration or execution of a Federal program or policy; or (iv) The nomination or confirmation of a person subject to confirmation by the Senate.
(3) PENALTIES.—Any person who knowingly violates the provisions of this subsection shall be subject to: (A) A civil penalty of not more than $200,000 per violation; and (B) Criminal penalties including a fine under title 18, United States Code, or imprisonment for not more than 5 years, or both.
(b) PROHIBITION ON OWNERSHIP OF MEDICAL INDUSTRY SECURITIES.—
(1) IN GENERAL.—No officer, employee, contractor, or agent of the NHCP may own, purchase, or trade any stock, bond, or other security issued by any entity engaged in: (A) The manufacture or sale of pharmaceuticals; (B) The manufacture or sale of medical devices; (C) The ownership or operation of healthcare facilities; (D) The provision of health insurance; or (E) Any other business significantly involved in the healthcare industry, as determined by the Secretary.
(2) DIVESTITURE.—Any individual who becomes an officer, employee, contractor, or agent of the NHCP and who owns any security described in paragraph (1) shall: (A) Disclose such ownership to the Secretary within 30 days of appointment or employment; and (B) Divest all such securities within 180 days of appointment or employment.
(3) BLIND TRUSTS.—The prohibition in paragraph (1) shall not apply to securities held in a qualified blind trust, as defined in section 102(f)(3) of the Ethics in Government Act of 1978 (5 U.S.C. App.).
(4) EXCEPTIONS.—The Secretary may establish reasonable exceptions to the prohibitions in this subsection for: (A) Broadly diversified mutual funds or exchange-traded funds; and (B) De minimis holdings as defined by regulation.
(5) PENALTIES.—Any person who knowingly violates the provisions of this subsection shall be subject to: (A) Termination of employment or contract with the NHCP; (B) A civil penalty of not more than $50,000 per violation; and (C) Criminal penalties for knowingly and willfully falsifying or concealing material facts, including a fine under title 18, United States Code, or imprisonment for not more than 5 years, or both.
(c) FINANCIAL DISCLOSURE.—
(1) IN GENERAL.—Each officer and employee of the NHCP at or above the GS-15 level of the General Schedule shall file an annual financial disclosure report.
(2) CONTENTS.—The report required under paragraph (1) shall include: (A) A comprehensive list of all financial interests; (B) Sources of income; (C) Gifts received; and (D) Any other information required by the Office of Government Ethics.
(3) PUBLIC AVAILABILITY.—Financial disclosure reports filed under this subsection shall be made available to the public upon request, subject to redaction of personal identifying information.
Back to Table of ContentsSECTION 12. PROVIDER COMPENSATION.
(a) ANNUAL SALARY.—Healthcare providers employed under the NHCP shall receive an annual salary rather than fee-for-service payments.
(b) PERFORMANCE INCENTIVES.—
(1) The Secretary may establish a system of bonuses or other incentives for healthcare providers during: (A) National public health emergencies; or (B) Periods of demonstrated high need, as determined by the Secretary.
(c) WORKLOAD DETERMINATION.—The Secretary shall establish regulations to determine appropriate workloads for healthcare providers based on:
(1) Community healthcare needs; (2) Provider capacity; (3) Specialty-specific considerations; and (4) Such other factors as the Secretary determines appropriate.
(d) PAID LEAVE.—
(1) ANNUAL VACATION LEAVE.—All healthcare providers and staff employed under the NHCP shall receive a minimum of four (4) weeks of paid vacation leave per year.
(2) PARENTAL LEAVE.— (A) MATERNAL LEAVE.—Healthcare providers and staff employed under the NHCP who give birth shall receive: (i) Four (4) weeks of paid leave before the anticipated date of birth; and (ii) Sixteen (16) weeks of paid leave after the date of birth.
(B) PATERNAL LEAVE.—Healthcare providers and staff employed under the NHCP who are non-birth parents shall receive: (i) Two (2) weeks of paid leave before the anticipated date of birth or adoption; and (ii) Eight (8) weeks of paid leave after the date of birth or adoption.
(C) ADOPTION AND FOSTER CARE.—The parental leave provisions in this subsection shall apply equally to parents who adopt a child or accept a foster child placement.
(3) COMPENSATION DURING LEAVE.— (A) VACATION LEAVE.—During vacation leave described in paragraph (1), employees shall receive 100 percent of their regular salary and benefits.
(B) PARENTAL LEAVE.—During parental leave described in paragraph (2), employees shall receive 75 percent of their regular salary and 100 percent of their benefits.
(4) RETURN TO POSITION.—Employees taking leave under this subsection shall be entitled to return to the same or equivalent position upon completion of their leave period.
Back to Table of ContentsSECTION 13. TRANSITION OF MEDICAL PROVIDERS TO FEDERAL EMPLOYMENT.
(a) IN GENERAL.—The Secretary shall establish a program to transition healthcare providers to federal employment under the NHCP.
(b) INITIAL COMPENSATION SYSTEM.—
(1) DURATION.—The compensation system established in this subsection shall remain in effect for the first 5 years following the effective date of this Act.
(2) COMPENSATION OPTIONS.—Healthcare providers employed under this section shall have the option to receive either: (A) An annual base salary equal to the national median salary for their job title or specialty, as determined by the Secretary, plus an additional sum of $10,000 per year; or (B) Their current annual salary at the time of transition to the NHCP.
(3) SALARY GROWTH LIMITATIONS.— (A) If a provider’s current annual salary selected under paragraph (2)(B) exceeds 125 percent of the national median salary plus $10,000 for their job title or specialty, such provider shall not be eligible for any cost-of-living adjustment or salary increase until their salary is less than 110 percent of the then-current national median salary for their job title or specialty. (B) The Secretary shall annually recalculate and publish the national median salary for each healthcare provider job title and specialty, which shall be based solely on the base compensation for such positions without including the additional sum specified in paragraph (2)(A).
(4) WORKLOAD.—Compensation shall be decoupled from the number of patients seen or procedures performed, except that additional compensation may be provided during declared public health emergencies or in areas of demonstrated need, as determined by the Secretary.
(c) PROCEDURE-BASED CERTIFICATION AND COMPENSATION SYSTEM DEVELOPMENT.—
(1) RESEARCH COMMISSION.— (A) ESTABLISHMENT.—Not later than 6 months after the effective date of this Act, the Secretary shall establish a Medical Procedure Valuation Commission (in this section referred to as the “Commission”) to conduct comprehensive research into the relative difficulty, complexity, skill requirements, and patient outcomes of various medical procedures across all specialties. (B) COMPOSITION.—The Commission shall be composed of: (i) Representatives from each medical specialty board recognized by the American Board of Medical Specialties; (ii) Representatives from nursing and allied health professional organizations; (iii) Healthcare economists and compensation specialists; (iv) Patient advocates; and (v) Public health experts. (C) DUTIES.—The Commission shall: (i) Develop objective criteria for evaluating procedure complexity, including technical difficulty, required training, complication risks, and specialized knowledge; (ii) Create a tiered classification system for procedures within each specialty; (iii) Establish certification standards for each procedure tier; (iv) Recommend appropriate compensation differentials for certified procedure capabilities; and (v) Design a transition plan from the initial compensation system to the procedure-based certification system.
(2) SPECIALTY CERTIFICATION BOARDS.— (A) ESTABLISHMENT.—For each medical specialty, the Secretary shall establish a Certification Board composed of leading practitioners, educators, and researchers in that specialty. (B) DUTIES.—Each Specialty Certification Board shall: (i) Develop detailed requirements for certification in specialized procedures within their specialty; (ii) Establish evaluation methods and performance metrics for certification; (iii) Review and approve initial certifications for existing practitioners based on experience, training, and demonstrated competency; and (iv) Design pathways for new practitioners to obtain procedural certifications.
(3) CERTIFICATION PATHWAYS.— (A) INITIAL CERTIFICATION.—During the 5-year development period, practitioners with demonstrated experience and competency in specialized procedures shall be eligible for initial certification through a portfolio review and practical evaluation process. (B) NEW CERTIFICATION.—The Specialty Certification Boards shall establish standardized training and evaluation protocols for practitioners seeking new procedural certifications, which shall include: (i) Supervised practice requirements under a certified practitioner; (ii) Minimum case volumes; (iii) Quality and outcome metrics; and (iv) Demonstration of proficiency through standardized assessments.
(4) COMPENSATION FRAMEWORK DEVELOPMENT.— (A) The Commission shall develop recommendations for a compensation framework that: (i) Maintains a base salary component aligned with provider specialty; (ii) Adds procedural certification bonuses based on the tier and number of certifications held; (iii) Includes incentives for maintaining multiple procedural certifications; and (iv) Balances rewards for specialized skills while maintaining cost control. (B) REGIONAL ADJUSTMENTS.—The framework shall include appropriate regional adjustments to incentivize procedural capability in underserved areas.
(5) IMPLEMENTATION TIMELINE.— (A) YEAR 1.—Development of evaluation criteria and procedural classification system; (B) YEAR 2.—Establishment of certification standards and initial certification processes; (C) YEAR 3.—Initial certification of existing practitioners; (D) YEAR 4.—Finalization of compensation framework and transition planning; and (E) AFTER YEAR 5.—Full implementation of the procedure-based certification and compensation system.
(6) REPORTING REQUIREMENTS.— (A) The Commission shall submit semiannual progress reports to Congress. (B) Not later than 4 years after the effective date of this Act, the Commission shall submit final recommendations for the procedure-based certification and compensation system to the Secretary and to Congress. (C) Not later than 4 years and 6 months after the effective date of this Act, the Secretary shall publish final regulations implementing the procedure-based certification and compensation system.
(d) GEOGRAPHIC DISTRIBUTION AND INCENTIVES.—
(1) NEEDS-BASED ASSIGNMENT.—The Secretary shall establish a system for appropriate geographic distribution of healthcare providers to address areas of need, particularly in underserved and rural areas.
(2) VOLUNTARY ASSIGNMENT PRIORITY.—The Secretary shall prioritize voluntary assignment of providers to needed locations before requiring relocation.
(3) RELOCATION INCENTIVES.—For healthcare providers who voluntarily accept assignments to areas designated as underserved or having critical healthcare provider shortages, the Secretary shall provide: (A) Relocation assistance of not less than $50,000 for any provider required to move more than 100 miles; (B) A salary incentive of not less than 15 percent above the provider’s base salary for the duration of their assignment in the designated area; (C) Educational loan repayment acceleration for qualifying providers; and (D) Priority consideration for future assignment requests after completion of service in an underserved area.
(4) MANDATORY ASSIGNMENTS.—If insufficient providers voluntarily accept assignments to areas of critical need: (A) The Secretary may require temporary assignment of providers to such areas; (B) Any provider under mandatory assignment shall receive the same financial incentives as those who volunteer; and (C) No provider shall be required to serve in a mandatory assignment for more than three years during their NHCP employment, nor more than two years consecutively.
(5) FACTORS IN ASSIGNMENT.—When determining assignments, the Secretary shall consider: (A) Provider specialty and skills; (B) Family circumstances and hardships; (C) Prior service in underserved areas; and (D) Educational and professional development needs.
(e) MEDICAL RESIDENTS AND INTERNS.—
(1) STIPENDS.— (A) INTERNS.—Medical interns shall receive compensation equal to 70 percent of the base pay rate of the lowest tier of physician at the facility at which they work. (B) RESIDENTS.—Medical residents shall receive compensation equal to 85 percent of the base pay rate of the lowest tier of physician at the facility at which they work.
(2) TUITION RELIEF.—Medical residents and interns shall be eligible for tuition relief and student loan forgiveness programs established by the Secretary.
(3) FEDERAL BENEFITS.—Medical residents and interns shall be eligible for federal employee benefits.
(f) IMPLEMENTATION.—
(1) TRANSITION PLAN.—The Secretary shall develop a detailed plan for the orderly transition of healthcare providers to federal employment, including: (A) A timeline for transition by specialty and geographic area; (B) Procedures for determination and verification of current salaries; (C) Methods for aligning provider distribution with population needs; and (D) A process for appealing compensation or assignment decisions.
(2) RETENTION OF PRIVATE PRACTICE OPTION.—Healthcare providers may maintain limited private practices outside of NHCP employment, provided that: (A) Such practice does not interfere with their NHCP duties; (B) Services provided in private practice are clearly distinguished from NHCP services; and (C) Providers comply with all transparency and ethics requirements established by the Secretary.
Back to Table of ContentsSECTION 14. TRANSITION OF HEALTH INSURANCE WORKERS.
(a) IMPACT ASSESSMENT AND ASSISTANCE.—
(1) WORKFORCE ASSESSMENT.—Within 6 months of enactment of this Act, the Secretary of Labor shall conduct an assessment of the potential impact on the health insurance industry workforce, including: (A) The number of workers likely to be displaced; (B) Geographic distribution of affected workers; (C) Skill sets and transferable competencies of affected workers; and (D) Projected job creation in related sectors, including NHCP administration and supplemental insurance administration.
(2) PRIORITY HIRING.—Employees of health insurance companies whose positions are eliminated or substantially reduced as a result of this Act shall receive priority consideration for: (A) Employment with CMS to implement the NHCP; (B) Employment in other federal agencies requiring similar skill sets; and (C) Training programs established under paragraph (4).
(3) COMPENSATION.— (A) IN GENERAL.—Individuals hired under paragraph (2)(A) shall receive an annual base salary equal to: (i) The median salary of their prior job title, as determined by the Secretary, plus (ii) An additional sum of $7,500 per year. (B) EXECUTIVE COMPENSATION.—Former executives of health insurance companies hired for management positions shall receive a salary not to exceed 5 times the median salary of non-leadership roles within CMS.
(4) WORKFORCE TRANSITION ASSISTANCE.— (A) ESTABLISHMENT.—The Secretary of Labor shall establish a Health Insurance Workforce Transition Program to assist workers displaced by the implementation of this Act. (B) COMPONENTS.—The program shall include: (i) Job search assistance and career counseling; (ii) Retraining programs focused on skills needed for NHCP administration, supplemental insurance operations, healthcare delivery support, and related fields; (iii) Relocation assistance for workers who secure employment requiring relocation; and (iv) Extended unemployment benefits for displaced workers participating in training programs.
(5) SMALL BUSINESS TRANSITION.— (A) ASSESSMENT.—The Administrator of the Small Business Administration, in consultation with the Secretary, shall conduct an assessment of small insurance brokerages, agencies, and related businesses affected by the transition to the NHCP. (B) ASSISTANCE.—Based on the assessment, the Administrator shall establish a program to provide: (i) Technical assistance for small businesses transitioning to provide supplemental insurance services; (ii) Business counseling for owners seeking to repurpose their businesses; and (iii) Access to low-interest loans for business model transitions.
(6) INCOME PROTECTION.— (A) ESTABLISHMENT.—The Secretary of Labor shall establish a Health Insurance Industry Transition Income Protection Program to provide financial stability for workers displaced by the implementation of this Act. (B) ELIGIBILITY.—Workers who can demonstrate that their employment was terminated or substantially reduced as a direct result of the transition to the NHCP shall be eligible. (C) BENEFITS.—Eligible workers shall receive: (i) Income replacement of 80% of their previous salary for up to 12 months following displacement; (ii) Continuation of employer-provided health benefits until NHCP implementation is complete; (iii) Extension of income support for an additional 12 months for workers within 5 years of retirement age; and (iv) Graduated reduction of benefits for those who secure employment at lower compensation than their previous position.
(7) CAREER TRANSITION PATHWAYS.— (A) HEALTHCARE ADMINISTRATION PATHWAY.— (i) The Secretary shall establish a Healthcare Administration Conversion Program that provides: (I) Expedited training and certification in NHCP administrative functions; (II) Paid apprenticeships within CMS and other NHCP administrative offices; (III) Placement assistance within the NHCP administration; and (IV) Relocation assistance when necessary. (B) HEALTHCARE DELIVERY PATHWAY.— (i) The Secretary shall establish a Healthcare Provider Training Program that provides: (I) Tuition coverage for displaced workers pursuing degrees or certifications in nursing, medical assisting, community health work, or other clinical support roles; (II) Living stipends during the education period; (III) Placement assistance within NHCP facilities upon completion; and (IV) Expedited training programs developed in partnership with community colleges and technical schools. (C) TECHNOLOGY TRANSITION PATHWAY.— (i) The Secretary shall establish a Health Technology Transition Program that provides: (I) Specialized training in health information technology, data analysis, and digital health systems; (II) Certification programs in electronic health records management; (III) Partnerships with technology companies for job placement; and (IV) Entrepreneurship support for technology innovations that complement the NHCP.
(8) REGIONAL TRANSITION CENTERS.— (A) ESTABLISHMENT.—The Secretary of Labor shall establish Regional Health Insurance Transition Centers in areas with high concentrations of health insurance industry employment. (B) SERVICES.—Each Center shall provide: (i) One-on-one career counseling and case management; (ii) On-site training and education programs; (iii) Job fairs and employer matching services; (iv) Mental health and financial counseling services; (v) Small business development resources; and (vi) Community support networks for displaced workers. (C) DURATION.—Centers shall remain operational for at least 3 years after full NHCP implementation.
(9) EARLY RETIREMENT PROGRAM.— (A) ELIGIBILITY.—Health insurance industry workers who are within 7 years of Medicare eligibility age at the time of displacement shall be eligible for an early retirement program. (B) BENEFITS.—Eligible workers shall receive: (i) A bridge payment equivalent to Social Security benefits they would receive at full retirement age until they reach actual eligibility; (ii) Medicare coverage through the transition period to the NHCP; (iii) Credit toward Social Security earnings for the bridge period; and (iv) Financial planning assistance specifically tailored to early retirees. (C) PARTIAL WORK OPTION.—Program participants may work part-time without losing benefits, with a graduated reduction in bridge payments.
(10) ENTREPRENEURSHIP ASSISTANCE.— (A) ESTABLISHMENT.—The Small Business Administration, in coordination with the Secretary of Labor, shall establish a Health Economy Entrepreneurship Program. (B) SERVICES.—The program shall provide: (i) Low-interest loans up to $250,000 for displaced workers starting businesses that complement the NHCP; (ii) Technical assistance and business planning; (iii) Procurement preference for NHCP-related contracts; (iv) Incubator spaces in regions with high displacement rates; and (v) Mentorship from established healthcare entrepreneurs. (C) TARGETED SECTORS.—Priority shall be given to businesses focused on: (i) Preventive health services; (ii) Home health technology; (iii) Health data analytics; (iv) Patient advocacy services; and (v) Supplemental service coordination.
(11) COMMUNITY ECONOMIC STABILIZATION.— (A) IDENTIFICATION.—The Secretary of Labor shall identify communities where health insurance industry employment exceeds 15% of the local workforce. (B) ECONOMIC DEVELOPMENT GRANTS.—Such communities shall be eligible for: (i) Economic diversification grants up to $30 million; (ii) Infrastructure development funding to attract new industries; (iii) Small business development incentives; and (iv) Educational institution partnerships to develop new economic opportunities. (C) IMPLEMENTATION.—Grants shall be implemented through partnerships with local governments, economic development organizations, and community representatives.
(12) OVERSIGHT AND ACCOUNTABILITY.— (A) WORKER ADVISORY BOARD.— (i) ESTABLISHMENT.—There is established a Health Insurance Worker Transition Advisory Board composed of: (I) Representatives from health insurance worker organizations; (II) Employers in the health insurance industry; (III) Labor economists; (IV) Workforce development specialists; and (V) Affected workers. (ii) DUTIES.—The Board shall: (I) Monitor the effectiveness of transition programs; (II) Recommend improvements to the Secretary; (III) Ensure programs meet the needs of diverse worker populations; and (IV) Submit quarterly reports to Congress. (B) OUTCOME TRACKING.— (i) The Secretary of Labor shall establish a comprehensive tracking system to monitor: (I) Employment outcomes for displaced workers; (II) Wage replacement rates; (III) Utilization of transition programs; (IV) Regional economic impacts; and (V) Long-term career trajectories of affected workers. (ii) ANNUAL REPORTS.—The Secretary shall submit annual reports to Congress on program outcomes, continuing for 5 years after full NHCP implementation.
(13) ADVANCE PLANNING AND PREPARATION.— (A) EARLY IMPLEMENTATION.—The Secretary of Labor shall begin implementing the provisions of this section within 90 days after the date of enactment of this Act, before the major displacement of workers begins. (B) PHASED SUPPORT.— (i) PHASE 1 (MONTHS 1-12)—Program development, resource allocation, and pre-emptive training options for workers in affected industries; (ii) PHASE 2 (MONTHS 13-24)—Full program implementation coinciding with initial health insurance industry contractions; and (iii) PHASE 3 (MONTHS 25-60)—Continued support, monitoring, and adaptation of programs based on outcome data.
(b) REPORTING AND OVERSIGHT.— (1) QUARTERLY REPORTS.—The Secretary of Labor shall submit quarterly reports to Congress on: (A) The status of the health insurance industry transition; (B) Utilization of transition assistance programs; (C) Employment outcomes for displaced workers; and (D) Recommendations for additional legislative action if needed.
(2) OVERSIGHT COMMITTEE.—The Secretary shall establish a Health Insurance Workforce Transition Oversight Committee, comprised of representatives from labor, industry, government, and academia, to monitor the effectiveness of transition programs and recommend improvements.
Back to Table of ContentsSECTION 15. MEDICAL EDUCATION SUPPORT.
(a) SCHOLARSHIPS AND LOAN FORGIVENESS.—
(1) IN GENERAL.—The Secretary shall establish a program to provide: (A) Full scholarships for medical education; (B) Stipends for medical students; and (C) Student loan forgiveness for healthcare professionals.
(2) PRIORITY.—In awarding assistance under paragraph (1), the Secretary shall give priority to individuals pursuing education in high-need specialties, including: (A) Rural medicine; (B) Primary care; (C) Geriatrics; and (D) Such other specialties as the Secretary determines appropriate.
(b) RESIDENCY EXPANSION.—The Secretary shall establish a program to expand the number of medical residency positions to meet national healthcare demands.
Back to Table of ContentsSECTION 16. INFRASTRUCTURE AND ACCESS.
(a) MODERNIZATION.—The Secretary shall establish a program to repair and modernize existing underperforming hospitals and healthcare facilities.
(b) CONSTRUCTION.—The Secretary shall establish a program to construct new healthcare facilities to ensure that no resident of the United States lives more than 50 miles from a hospital or appropriate healthcare facility.
(c) ANALYSIS.—The Secretary shall conduct ongoing analysis of population density and healthcare needs to ensure sufficient hospital and healthcare facility access for all residents.
Back to Table of ContentsSECTION 17. AMBULANCE SERVICES.
(a) CONTRACTED SERVICES.—The Secretary may enter into contracts with private ambulance companies to provide emergency transportation services under the NHCP.
(b) RATES.—Private ambulance companies may bill the Federal Government at rates established by the Secretary.
(c) UNDERSERVED AREAS.—
(1) IN GENERAL.—The Secretary shall establish a program to subsidize new and existing ambulance services in underserved or rural areas.
(2) PRIORITY.—Priority shall be given to expanding emergency response coverage nationwide.
Back to Table of ContentsSECTION 18. MALPRACTICE LIABILITY REFORM.
(a) FEDERAL LIABILITY.—The Federal Government shall be the sole defendant in medical malpractice lawsuits arising from care provided under the NHCP.
(b) COMPENSATION FUND.—
(1) ESTABLISHMENT.—There is established a Federal Malpractice Compensation Fund to: (A) Process and pay settlements for valid medical malpractice claims; (B) Support quality improvement initiatives to address systemic issues; and (C) Provide fair and timely compensation to victims of medical negligence.
(2) ADMINISTRATION.—The Fund shall be administered by the Secretary in accordance with regulations promulgated by the Secretary.
(c) ATTORNEY’S FEES.—
(1) IN GENERAL.—For any non-frivolous malpractice claim filed under this section, the Federal Government shall bear reasonable attorney’s costs for all parties to the litigation.
(2) DETERMINATION OF REASONABLENESS.—The Secretary shall establish regulations defining “reasonable attorney’s costs” for purposes of this subsection.
(3) DETERMINATION OF FRIVOLOUSNESS.—A claim shall be deemed frivolous if a court determines that the claim: (A) Has no basis in law or fact; (B) Was filed for an improper purpose, such as to harass or cause unnecessary delay; or (C) Makes allegations unsupported by any medical evidence.
(d) PENALTY FOR ABUSE.—
(1) IN GENERAL.—Any person who knowingly files a frivolous medical malpractice claim under this Act, as determined by a court of competent jurisdiction, shall be guilty of a Class E felony.
(2) PENALTIES.—A person convicted of an offense under paragraph (1) shall be subject to a fine under title 18, United States Code, or imprisonment for not more than 5 years, or both.
Back to Table of ContentsSECTION 19. INTEGRATION OF MEDICAID PROGRAMS.
(a) IN GENERAL.—All State Medicaid programs shall be integrated into the NHCP established under this Act.
(b) TRANSITION PERIOD.—The Secretary shall establish a transition period and process to ensure that all individuals currently enrolled in State Medicaid programs maintain healthcare coverage during the transition to the NHCP.
Back to Table of ContentsSECTION 20. PRIVATE HEALTH INSURANCE AND SUPPLEMENTAL COVERAGE.
(a) RELATIONSHIP TO PRIVATE HEALTH INSURANCE.— (1) CONTINUATION OF PRIVATE INSURANCE.—Nothing in this Act shall be construed to prohibit private health insurers from offering health insurance coverage to individuals for any healthcare services, whether or not such services are covered under the NHCP. (2) NO EXEMPTION FROM PROGRAM CONTRIBUTIONS.—Enrollment in private health insurance plans shall not exempt any individual or employer from the tax contributions required to fund the NHCP under Section 22 of this Act. (3) NO SUBSTITUTION FOR COVERAGE.—Private health insurance shall be supplemental to, and not a substitute for, coverage under the NHCP. All residents of the United States remain enrolled in and entitled to benefits under the NHCP regardless of any private insurance coverage they may maintain. (b) EMPLOYER-SPONSORED COVERAGE.— (1) OPTION TO PROVIDE SUPPLEMENTAL COVERAGE.—Subject to the transition provisions in Section 28, employers may offer supplemental health benefits through a group health plan in addition to the coverage provided under the NHCP. (2) REALLOCATION OF EMPLOYER CONTRIBUTIONS.— (A) DISCLOSURE REQUIREMENTS.—Employers who cease providing or reduce health benefits as a result of this Act shall: (i) Disclose to employees the reduction in employer healthcare spending; (ii) Provide employees with written documentation of the employer’s healthcare spending per employee for the year prior to the implementation of the NHCP; and (iii) Report to the Secretary of Labor on the reallocation of prior healthcare spending. (B) COLLECTIVE BARGAINING.—For employees covered by collective bargaining agreements, any reallocation of employer healthcare spending shall be subject to good faith bargaining between the employer and the employees’ representatives. (C) REGULATIONS.—The Secretary of Labor, in consultation with the Secretary, shall promulgate regulations governing the disclosure and reporting requirements under this paragraph. (c) PERMITTED SCOPE OF PRIVATE COVERAGE.— (1) PRIVATE HEALTHCARE SERVICES.—Nothing in this Act shall be construed as prohibiting any individual from purchasing any healthcare service directly from a healthcare provider. (2) SUPPLEMENTAL INSURANCE.—Private health insurance may provide coverage for: (A) Benefits covered under the NHCP, which may provide: (i) Access to different or expanded provider networks; (ii) Reduced wait times for non-emergency services; (iii) Enhanced amenities during hospital stays or medical procedures; or (iv) Other supplemental benefits that enhance but do not replace NHCP coverage; (B) Cosmetic procedures or other services and items that are not medically necessary; (C) Access to healthcare providers who do not participate in the NHCP; (D) Coverage for healthcare services received outside the United States; and (E) Premium services that exceed NHCP standards. (3) COLLECTIVE BARGAINING AGREEMENTS.—Group health plans maintained pursuant to collective bargaining agreements in effect on the date of enactment of this Act may continue to provide healthcare benefits until the date on which the last of the collective bargaining agreements relating to the plan terminates, subject to the transition provisions in Section 28. (d) COORDINATION OF BENEFITS.— (1) PRIMARY PAYER STATUS.—The NHCP shall be the primary payer for all services covered under this Act, regardless of whether an individual maintains private insurance coverage for such services. (2) SECONDARY PAYER RULES.—The Secretary shall establish regulations governing the coordination of benefits between the NHCP and private insurance plans. (3) PROHIBITION ON BALANCE BILLING.—Healthcare providers who participate in the NHCP may not bill private insurance plans or individuals for amounts in excess of the rates established under the NHCP for services covered by the program. (e) CONSUMER PROTECTIONS.— (1) TRANSPARENCY REQUIREMENTS.—Private health insurers offering supplemental coverage shall clearly disclose to consumers: (A) Which benefits are already covered under the NHCP at no additional cost; (B) The specific additional benefits or enhanced services provided by the supplemental plan; and (C) All premiums, cost-sharing, and other expenses associated with the supplemental coverage. (2) MARKETING RESTRICTIONS.—The Secretary shall promulgate regulations prohibiting deceptive marketing practices of supplemental insurance plans that misrepresent the need for or benefits of such coverage in relation to the NHCP. (f) SUPPLEMENTAL HEALTH BENEFIT PLANS.— (1) PERMISSIBLE STRUCTURE.—Employers may establish supplemental health benefit plans consistent with the requirements of this Act and Section 801(c) of the Employee Retirement Income Security Act of 1974 (as added by Section 28 of this Act). (2) FIDUCIARY STANDARDS.—Supplemental health benefit plans shall be subject to the fiduciary standards of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.).
Back to Table of ContentsSECTION 21. REGULATED HEALTH INNOVATION INDUSTRY.
(a) ESTABLISHMENT.—There is established a federally regulated health innovation industry classification for:
(1) Pharmaceutical companies; and (2) Medical technology developers.
(b) RESEARCH GRANTS.—
(1) IN GENERAL.—The Secretary shall establish a program to provide annual research grants to entities classified under subsection (a).
(2) CONDITIONS.—As a condition of receiving a grant under this subsection, an entity shall agree to: (A) Sell products to the Federal Government at discounted prices as determined by the Secretary; (B) Allow the Federal Government to license innovations developed with grant funding; and (C) Permit the Federal Government to export such innovations to other countries.
(c) PRIVATE OPERATION.—Entities classified under subsection (a) shall remain privately operated but subject to public accountability measures established by the Secretary.
Back to Table of ContentsSECTION 22. FUNDING.
(a) GENERAL FUNDING PRINCIPLES.—
(1) COMPREHENSIVE APPROACH.—Funding for the NHCP shall utilize a diverse, progressive, and sustainable funding structure that: (A) Equitably distributes the financial responsibility across individuals, employers, and other revenue sources; (B) Ensures that the NHCP is adequately funded to provide comprehensive benefits to all residents; and (C) Protects long-term fiscal stability through multiple revenue streams.
(2) REDIRECTED HEALTHCARE FUNDING.—Existing federal, state, and local government healthcare expenditures shall be repurposed to fund the NHCP, including funds from: (A) Medicare; (B) Medicaid; (C) The Children’s Health Insurance Program; (D) Federal and state employee health benefits programs; (E) The Veterans Health Administration (to the extent provided under Section 29); (F) TRICARE (to the extent provided under Section 29); (G) The Indian Health Service; and (H) Premium tax credits, cost-sharing subsidies, and other federal healthcare expenditures.
(b) MEDICARE PAYROLL TAX ADJUSTMENT.—
(1) EMPLOYEE CONTRIBUTION.—Section 3101(b) of the Internal Revenue Code of 1986 is amended by striking “1.45 percent” and inserting the following: “(A) 2.45 percent for wages received during the 1-year period beginning on the effective date of the American Health Care Freedom Act”; “(B) 3.45 percent for wages received during the 1-year period beginning 1 year after such effective date”; “(C) 5.25 percent for wages received during the 1-year period beginning 2 years after such effective date”; and “(D) 7 percent for wages received during any period beginning 3 years after such effective date.”
(2) EMPLOYER CONTRIBUTION.—Section 3111(b) of such Code is amended by adding a new subsection as follows: “(1) SMALL EMPLOYER CONTRIBUTION.—For employers with fewer than 50 employees in the preceding calendar year, the applicable percentage shall be: (A) 2.5 percent for wages paid during the 1-year period beginning on the effective date of the American Health Care Freedom Act; (B) 3.5 percent for wages paid during the 1-year period beginning 1 year after such effective date; and (C) 5 percent for wages paid during any period beginning 2 years after such effective date.
“(2) MEDIUM EMPLOYER CONTRIBUTION.—For employers with 50 to 499 employees in the preceding calendar year, the applicable percentage shall be: (A) 6.5 percent for wages paid during the 1-year period beginning on the effective date of the American Health Care Freedom Act; (B) 7.5 percent for wages paid during the 1-year period beginning 1 year after such effective date; and (C) 9 percent for wages paid during any period beginning 2 years after such effective date.
“(3) LARGE EMPLOYER CONTRIBUTION.—For employers with 500 or more employees in the preceding calendar year, the applicable percentage shall be: (A) 6.5 percent for wages paid during the 1-year period beginning on the effective date of the American Health Care Freedom Act; (B) 9.5 percent for wages paid during the 1-year period beginning 1 year after such effective date; and (C) 12.5 percent for wages paid during any period beginning 2 years after such effective date.
“(3) EMPLOYEE COUNT DETERMINATION.— (A) IN GENERAL.—For purposes of determining the applicable contribution rate under this subsection, the number of employees of an employer shall be determined by calculating the average number of full-time equivalent employees employed during the preceding calendar year. (B) FULL-TIME EQUIVALENT.—The term ‘full-time equivalent’ means a number of employees equal to the number determined by dividing— (i) the total number of hours of service for which wages were paid by the employer to employees during the preceding calendar year, by (ii) 2,080. (C) ROUNDING.—The number determined under subparagraph (B) shall be rounded to the next lowest whole number. (D) EMPLOYERS NOT IN EXISTENCE IN PRECEDING YEAR.—In the case of an employer which was not in existence throughout the preceding calendar year, the determination of the number of employees shall be based on the average number of employees that it is reasonably expected such employer will employ on business days in the current calendar year.”
(4) SELF-EMPLOYMENT TAX.—Section 1401(b) of such Code is amended by striking “2.9 percent” and inserting the following: “(A) 3.5 percent for taxable years beginning during the 1-year period beginning on the effective date of the American Health Care Freedom Act”; “(B) 4.9 percent for taxable years beginning during the 1-year period beginning 1 year after such effective date”; “(C) 5.5 percent for taxable years beginning during any period beginning 2 years after such effective date.”; and “(D) 7 percent for wages received during any period beginning 3 years after such effective date.”
(4) ECONOMIC IMPACT ASSESSMENT.— (A) REPORTING REQUIREMENT.—Not later than 6 months after each payroll tax adjustment under paragraphs (1), (2), and (3), the Secretary, in coordination with the Secretary of the Treasury and the Secretary of Labor, shall submit a report to Congress on the economic impact of such adjustment. (B) CONTENTS.—Each report required under subparagraph (A) shall include analysis of: (i) Effects on employment levels and labor market participation; (ii) Effects on wages and total compensation; (iii) Impacts on different economic sectors, industries, and geographic regions; (iv) Effects on small businesses and entrepreneurship; (v) Healthcare cost offsets for employers and employees from reduced private insurance premiums; and (vi) Impacts on households at different income levels. (C) MITIGATION MEASURES.—If a report identifies significant adverse economic impacts, the Secretary shall propose mitigation measures, which may include adjustment of the implementation timeline.
(c) ELIMINATION OF INCOME CAP.—
(1) PHASED IMPLEMENTATION.—Section 3121(a)(1) of such Code is amended by inserting after “such calendar year.” the following: “(A) Effective 1 year after the effective date of the American Health Care Freedom Act, the preceding sentence shall not apply to 25 percent of wages paid for Medicare tax purposes. (B) Effective 2 years after such effective date, the preceding sentence shall not apply to 50 percent of wages paid for Medicare and Social Security tax purposes. (C) Effective 3 years after such effective date, the preceding sentence shall not apply to 75 percent of wages paid for Medicare and Social Security tax purposes. (D) Effective 4 years after such effective date, the preceding sentence shall not apply to wages paid for Medicare and Social Security tax purposes.”
(2) ECONOMIC IMPACT ANALYSIS.— (A) ONGOING STUDY.—The Secretary, in coordination with the Social Security Administration, shall conduct a continuing study of the economic impact of eliminating the income cap on Social Security and Medicare taxes, with particular attention to: (i) Effects on retirement security and Social Security solvency; (ii) Labor market effects for high-income earners; (iii) Effects on investment and capital formation; and (iv) Distributional impacts across income levels and geographic regions. (B) ANNUAL REPORTS.—The Secretary shall submit annual reports to Congress on the findings of the study conducted under subparagraph (A), including any recommendations for adjustments to the implementation schedule or complementary policies.
(d) INDIVIDUAL INCOME TAX MODIFICATIONS.—
(1) RETURN TO PRE-2017 TAX RATE STRUCTURE.—The amendments made to the individual income tax rates by section 11001 of Public Law 115-97 shall not apply to taxable years beginning after December 31, 2025.
(2) CHILD TAX CREDIT ADJUSTMENT.—Section 24(a) of the Internal Revenue Code of 1986 is amended by striking “$2,000” and inserting “$1,500”.
(3) MODIFIED STANDARD DEDUCTION AND PERSONAL EXEMPTIONS.— (A) The amendments made to the standard deduction by section 11021 of Public Law 115-97 shall not apply to taxable years beginning after December 31, 2025. (B) The amendments made to personal exemptions by section 11041 of Public Law 115-97 shall not apply to taxable years beginning after December 31, 2025.
(4) STATE AND LOCAL TAX DEDUCTION CAP.—Section 164(b)(6) of the Internal Revenue Code of 1986 is amended by striking “$10,000 ($5,000 in the case of a married individual filing a separate return)” and inserting “$20,000 ($10,000 in the case of a married individual filing a separate return)”.
(5) PHASE-IN.—The Secretary of the Treasury shall establish regulations to provide for an orderly transition to the tax provisions in this subsection, which may include: (A) Gradual phase-in of rate adjustments; (B) Transitional relief provisions; and (C) Advanced notification requirements to provide taxpayers with sufficient time to adjust to the modified tax provisions.
(e) CORPORATE TAX MODIFICATIONS.—
(1) RETURN TO PRE-2017 CORPORATE TAX RATE STRUCTURE.—The amendments made to the corporate tax rate by section 13001 of Public Law 115-97 shall not apply to taxable years beginning after December 31, 2025.
(2) CORPORATE MINIMUM TAX.— (A) IN GENERAL.—Subtitle A of the Internal Revenue Code of 1986 is amended by adding at the end the following new chapter:
“CHAPTER 50—CORPORATE MINIMUM TAX
“Sec. 5000. Corporate minimum tax.
“(a) IMPOSITION OF TAX.— “(1) IN GENERAL.—There is hereby imposed on each applicable corporation a tax equal to 16.5 percent of the adjusted financial statement income for the taxable year, reduced by the corporate minimum tax foreign credit determined under subsection (d). “(2) APPLICABLE CORPORATION.—For purposes of this section, the term ‘applicable corporation’ means any corporation (other than an S corporation, a regulated investment company, or a real estate investment trust) that meets the average annual adjusted financial statement income test of paragraph (3) for one or more taxable years ending after December 31, 2025. “(3) AVERAGE ANNUAL ADJUSTED FINANCIAL STATEMENT INCOME TEST.—For purposes of this section, a corporation meets the average annual adjusted financial statement income test for any taxable year if the average annual adjusted financial statement income of such corporation for the 3-taxable-year period ending with such taxable year exceeds $100,000,000.
“(b) ADJUSTED FINANCIAL STATEMENT INCOME.—For purposes of this section, the term ‘adjusted financial statement income’ means, with respect to any corporation for any taxable year, the net income or loss of the taxpayer set forth on the taxpayer’s applicable financial statement for such taxable year, adjusted as provided in this section.
“(c) REGULATIONS AND OTHER GUIDANCE.—The Secretary shall prescribe such regulations and other guidance as necessary or appropriate to carry out the purposes of this section, including regulations and other guidance relating to the effect of the rules of this section on partnerships with income taken into account by an applicable corporation.”
(3) PASS-THROUGH BUSINESS DEDUCTION LIMITATION.—The amendments made by section 11011 of Public Law 115-97 shall not apply to taxable years beginning after December 31, 2025.
(4) BUSINESS EXPENSING MODIFICATIONS.—The amendments made by section 13201 of Public Law 115-97 shall not apply to property placed in service after December 31, 2025.
(5) INTERNATIONAL TAX PROVISIONS.— (A) GLOBAL INTANGIBLE LOW-TAXED INCOME.—The amendments made by section 14201 of Public Law 115-97 shall not apply to taxable years beginning after December 31, 2025. (B) FOREIGN-DERIVED INTANGIBLE INCOME.—The amendments made by section 14202 of Public Law 115-97 shall not apply to taxable years beginning after December 31, 2025. (C) BASE EROSION AND ANTI-ABUSE TAX.—The amendments made by section 14401 of Public Law 115-97 shall not apply to taxable years beginning after December 31, 2025.
(f) ESTATE TAX EXEMPTION MODIFICATION.—
(1) IN GENERAL.—Section 2010(c)(3) of the Internal Revenue Code of 1986 is amended by striking “$5,000,000” and inserting “$2,000,000”.
(2) INFLATION ADJUSTMENT.—Section 2010(c)(3) of such Code is amended by adding at the end the following: “In the case of estates of decedents dying in a calendar year after 2025, the $2,000,000 amount shall be increased by an amount equal to— “(A) such dollar amount, multiplied by “(B) the cost-of-living adjustment determined under section 1(f)(3) for such calendar year, determined by substituting ‘calendar year 2025’ for ‘calendar year 2016’ in subparagraph (A)(ii) thereof.”
(g) PHARMACEUTICAL REVENUE.—
(1) PHASED IMPLEMENTATION.—For the export of pharmaceutical products developed with the assistance of federal research funding, the following percentages of revenue shall be allocated to the NHCP established under this Act: (A) 5 percent for the 1-year period beginning on the effective date of this Act; (B) 10 percent for the 1-year period beginning 1 year after such effective date; and (C) 17 percent for periods beginning 2 years after such effective date.
(2) ECONOMIC AND INNOVATION IMPACT ASSESSMENT.— (A) STUDY REQUIREMENT.—The Secretary, in coordination with the Secretary of Commerce and the Director of the National Institutes of Health, shall conduct a biennial study on the impact of the revenue allocation requirement under paragraph (1) on: (i) Pharmaceutical research and development investment; (ii) Innovation in drug discovery and development; (iii) Drug pricing for domestic and international markets; (iv) U.S. pharmaceutical industry competitiveness; and (v) Access to essential medicines globally. (B) REPORT TO CONGRESS.—Not later than 2 years after the effective date of this Act, and every 2 years thereafter, the Secretary shall submit a report to Congress containing the findings of the study conducted under subparagraph (A) and recommendations for any legislative or regulatory adjustments.
(h) COMPREHENSIVE ECONOMIC IMPACT ANALYSIS.—
(1) ESTABLISHMENT OF ADVISORY COUNCIL.—There is established an Economic Impact Advisory Council (in this subsection referred to as the “Council”) to: (A) Monitor the combined economic effects of all revenue provisions under this section; (B) Analyze potential cumulative impacts on economic growth, employment, wages, investment, and international competitiveness; (C) Identify potential unintended consequences and distributional effects across income levels, demographic groups, industries, and geographic regions; and (D) Recommend policy refinements to minimize adverse economic impacts while ensuring adequate funding for the NHCP.
(2) COMPOSITION.—The Council shall be composed of 15 members, including: (A) The Secretary of the Treasury; (B) The Secretary of Labor; (C) The Secretary of Commerce; (D) The Director of the Congressional Budget Office; (E) The Chair of the Council of Economic Advisers; (F) Five economists with expertise in healthcare economics, tax policy, and macroeconomics, appointed by the President; and (G) Five representatives from diverse economic sectors, appointed by the President.
(3) ANNUAL COMPREHENSIVE ASSESSMENT.—The Council shall submit an annual report to Congress and the President containing: (A) Analysis of the combined economic effects of all revenue provisions; (B) Comparison of actual revenue generation against projections; (C) Assessment of healthcare cost savings for households and employers; (D) Identification of any sectors or regions experiencing disproportionate adverse impacts; and (E) Recommendations for policy adjustments to address identified issues.
(4) ADJUSTMENT AUTHORITY.—Based on the findings of the Council, the Secretary of the Treasury, in consultation with Congress, may temporarily modify implementation timelines or phase-in schedules of any revenue provision under this section to mitigate severe adverse economic impacts, provided that such modifications do not compromise the long-term financial stability of the NHCP.
(i) NHCP TRUST FUND.—
(1) ESTABLISHMENT.—There is hereby created on the books of the Treasury of the United States a trust fund to be known as the “National Health Care Program Trust Fund” (in this section referred to as the “Trust Fund”). The Trust Fund shall consist of such gifts and bequests as may be made and such amounts as may be deposited in, or appropriated to, such Trust Fund as provided in this Act.
(2) INCORPORATION OF EXISTING TRUST FUNDS.—The Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund shall be transferred into the Trust Fund upon implementation of the NHCP.
(3) APPROPRIATION OF AMOUNTS.—There are hereby appropriated to the Trust Fund for each fiscal year, out of any moneys in the Treasury not otherwise appropriated, amounts equivalent to 100 percent of: (A) The taxes imposed by sections 3101(b) and 3111(b) of the Internal Revenue Code of 1986 with respect to wages reported to the Secretary of the Treasury; and (B) The taxes imposed by section 1401(b) of the Internal Revenue Code of 1986 with respect to self-employment income reported to the Secretary of the Treasury; (C) The additional revenues resulting from the provisions of subsections (d), (e), (f), and (g) of this section.
(4) TRANSFER OF FUNDS.—The Secretary of the Treasury shall transfer to the Trust Fund, from time to time, the amounts appropriated under paragraph (3) from the general fund in the Treasury.
(5) MANAGEMENT OF TRUST FUND.— (A) BOARD OF TRUSTEES.—With respect to the Trust Fund, there is hereby created a body to be known as the “Board of Trustees of the Trust Fund” (in this section referred to as the “Board of Trustees”) composed of the Secretary of the Treasury, the Secretary of Labor, the Secretary of Health and Human Services, and the Commissioner of Social Security, all ex officio, and of five members of the public who shall be appointed by the President. The Board of Trustees shall meet not less frequently than once each calendar year. (B) DUTIES.—It shall be the duty of the Board of Trustees to: (i) Hold the Trust Fund; (ii) Report to the Congress not later than the first day of April of each year on the operation and status of the Trust Fund during the preceding fiscal year and on its expected operation and status during the current fiscal year and the next 5 fiscal years; (iii) Report immediately to the Congress whenever the Board is of the opinion that the amount in the Trust Fund is unduly small; and (iv) Review the general policies followed in managing the Trust Fund, and recommend changes in such policies.
(j) REVENUE SUFFICIENCY MECHANISM.—
(1) ANNUAL REVENUE ASSESSMENT.—The Secretary shall conduct an annual assessment of the revenues generated for the NHCP to determine if such revenues are sufficient to fund the benefits and administration of the program.
(2) DETERMINATION OF INSUFFICIENCY.—If the Secretary determines that revenues are insufficient to fully fund the NHCP for the following fiscal year, the Secretary shall: (A) Immediately notify Congress of the projected shortfall; (B) Implement cost-saving measures that do not reduce benefits or access to care; and (C) Propose revenue adjustments to ensure the long-term financial stability of the NHCP.
(3) CONGRESSIONAL REVIEW.—Upon notification of a projected revenue shortfall under paragraph (2), Congress shall review the Secretary’s findings and recommended revenue adjustments, and may enact legislation to address the shortfall.
(4) TEMPORARY ADJUSTMENT AUTHORITY.—If Congress has not enacted legislation to address a revenue shortfall within 120 days after notification under paragraph (2), the Secretary may temporarily adjust the Medicare payroll tax rates under subsection (b) by not more than 0.5 percentage points until Congress takes action or the shortfall is otherwise addressed, provided that: (A) Any such adjustment must be proportionally distributed between employer and employee contributions; (B) The Secretary must provide at least 60 days’ public notice before implementing the adjustment; and (C) The Secretary must report to Congress every 90 days on the impact of the adjustment and the status of the shortfall.
(k) WORKER TRANSITION SUPPORT FUNDING.—
(1) ALLOCATION FOR TRANSITION SUPPORT.—There shall be allocated from the Trust Fund such sums as may be necessary to implement the enhanced worker transition support programs established under Section 14 of this Act, not to exceed $60 billion over the implementation period.
(2) ANNUAL ASSESSMENT.—The Secretary, in coordination with the Secretary of Labor, shall conduct an annual assessment of the utilization and effectiveness of worker transition support programs and may recommend adjustments to the allocation under paragraph (1) based on demonstrated needs.
(3) COST-BENEFIT ANALYSIS.—Not later than 3 years after the date of enactment of this Act, and every 2 years thereafter until 5 years after full NHCP implementation, the Secretary shall submit to Congress a report containing a cost-benefit analysis of the worker transition support programs, including: (A) Direct costs of program implementation; (B) Economic benefits from worker reemployment and skills development; (C) Social costs averted through rapid workforce transition; and (D) Long-term return on investment from workforce development initiatives.
Back to Table of ContentsSECTION 23. IMPLEMENTATION AND TRANSITION.
(a) TRANSITION PERIOD.—There shall be a three-year transition period for implementation of the NHCP, beginning on the date this Act is signed into law.
(b) IMPLEMENTATION TIMELINE.—
(1) PHASE 1: ADMINISTRATIVE SETUP (MONTHS 1-12)— (A) Establishment of the National Health Care Program Division within CMS; (B) Appointment of the National Health Advisory Board; (C) Development of regulations, administrative procedures, and technology infrastructure; (D) Initial hiring of administrative personnel; (E) Development of provider payment schedules and compensation systems; (F) Establishment of the Federal Malpractice Compensation Fund; and (G) Initiation of public education campaign.
(2) PHASE 2: INITIAL PROGRAM EXPANSION (MONTHS 13-24)— (A) Enrollment of all current Medicare, Medicaid, CHIP, and federal employee beneficiaries into the NHCP; (B) Transition of Federally Qualified Health Centers and rural health clinics to the NHCP; (C) Beginning of provider transition to federal employment; (D) Implementation of medical education support programs; (E) Beginning of pharmaceutical and medical technology procurement contracts; (F) Initial infrastructure upgrades and construction in high-need areas; and (G) Initiation of ERISA plan transitions in accordance with Section 28.
(3) PHASE 3: FULL IMPLEMENTATION (MONTHS 25-36)— (A) Enrollment of all remaining U.S. residents into the NHCP; (B) Completion of provider transition to federal employment; (C) Dissolution of for-profit health insurance for duplicate coverage; (D) Completion of integration of state Medicaid programs; (E) Full implementation of health infrastructure expansion; (F) Full implementation of the regulated health innovation industry; and (G) Completion of ERISA plan transitions in accordance with Section 28.
(c) PROGRESS REPORTS.—
(1) The Secretary shall submit quarterly progress reports to Congress on the implementation of the NHCP during the transition period.
(2) Each report shall include: (A) Status updates on each implementation phase; (B) Identification of challenges and proposed solutions; (C) Budget expenditures and projections; and (D) Metrics on enrollment, provider participation, and service delivery.
Back to Table of ContentsSECTION 24. FEDERAL STANDARDS AND STATE IMPLEMENTATION.
(a) FEDERAL HEALTHCARE STANDARDS.—
(1) MINIMUM STANDARDS.—This Act establishes minimum federal standards for healthcare services and patient protections. All residents of the United States shall have access to healthcare services covered under this Act, regardless of the state in which they reside.
(2) STATE COMPLIANCE OPTIONS.—States may comply with the requirements of this Act by: (A) Adopting state laws, regulations, and policies that conform to or exceed the federal standards established under this Act; (B) Refraining from enforcing state laws that conflict with the federal standards established under this Act; or (C) Entering into cooperative agreements with the Federal Government for the implementation of the NHCP within the state.
(3) STATE INNOVATIONS.—Nothing in this Act shall be construed to prohibit states from: (A) Implementing additional healthcare programs that supplement but do not restrict the services provided under the NHCP; (B) Establishing higher standards of care than the minimum standards established under this Act; or (C) Developing innovative healthcare delivery models that achieve the objectives of this Act while adapting to local conditions and needs.
(b) CONFLICT RESOLUTION FRAMEWORK.—
(1) GENERAL PRINCIPLE.—In areas of direct conflict between this Act and state laws, where dual compliance is impossible, this Act shall govern with respect to: (A) Eligibility standards for healthcare services under the NHCP; (B) Scope of covered benefits under the NHCP; (C) Patient protections and privacy standards established under this Act; and (D) Provider participation standards and compensation under the NHCP.
(2) AREAS OF CRITICAL FEDERAL INTEREST.—The following healthcare services are deemed areas of critical federal interest where national uniformity is essential to fulfill the purposes of this Act: (A) Reproductive healthcare services, including but not limited to: (i) Access to abortion services; (ii) Access to contraception, including emergency contraception; (iii) Access to fertility treatments, including assisted reproductive technologies; and (iv) Access to appropriate miscarriage management and care; (B) Gender-affirming care, including but not limited to: (i) Access to hormone therapy when medically indicated; (ii) Access to puberty blockers when medically indicated; (iii) Access to gender-affirming surgeries when medically indicated; and (iv) Access to mental health services related to gender identity; (C) End-of-life care as specified under this Act; and (D) Any other medical procedure or service deemed medically necessary under Section 5 of this Act.
(3) STATE LAW RECONCILIATION.— (A) STATE AUTHORITY PRESERVED.—Except as provided in paragraph (1) and paragraph (2), states retain their traditional authority to regulate: (i) The practice of medicine and other healthcare professions within the state; (ii) State medical licensing and professional standards that exceed federal minimums; (iii) State healthcare facility licensing and operational requirements that exceed federal minimums; (iv) Public health measures that do not conflict with the provision of services under this Act; and (v) Other areas of traditional state health regulation that are compatible with the objectives of this Act. (B) COOPERATIVE FEDERALISM.—The Secretary shall establish an Office of State Coordination to: (i) Work with states to harmonize state laws with federal standards; (ii) Provide technical assistance to states in adapting state regulatory frameworks; (iii) Develop model state legislation that complies with this Act while preserving appropriate state authority; and (iv) Administer cooperative agreements with states for NHCP implementation.
(c) ENFORCEMENT MECHANISMS.—
(1) CERTIFICATION OF COMPLIANCE.— (A) STATE CERTIFICATION.—Each state shall annually certify to the Secretary whether: (i) The state has laws, regulations, and policies in place that conform to the requirements of this Act; (ii) The state refrains from enforcing laws that conflict with this Act in areas of critical federal interest; or (iii) The state has entered into a cooperative agreement for NHCP implementation. (B) SECRETARIAL DETERMINATION.—If the Secretary determines that a state’s certification under subparagraph (A) is not accurate, the Secretary shall: (i) Notify the state of the areas of non-compliance; (ii) Provide the state with 90 days to remedy the non-compliance; and (iii) If the state fails to remedy the non-compliance, initiate enforcement actions under paragraph (2).
(2) ENFORCEMENT ACTIONS.— (A) JUDICIAL ENFORCEMENT.—The Attorney General may bring a civil action in an appropriate United States district court to enforce the provisions of this Act when: (i) A state enacts or enforces laws that directly conflict with this Act in areas of critical federal interest; and (ii) Such enforcement substantially impedes residents’ access to healthcare services covered under this Act. (B) RELIEF.—In an action under subparagraph (A), the court may: (i) Issue declaratory judgments regarding the relationship between federal and state law; (ii) Grant appropriate injunctive relief to ensure access to healthcare services; (iii) Award compliance costs and attorney’s fees; and (iv) Issue such other relief as appropriate to ensure compliance with this Act while minimizing federal intrusion into legitimate state functions. (C) INTERVENTION.—In any action under this paragraph, the court may allow affected healthcare providers or patients to intervene.
(3) FUNDING INCENTIVES.— (A) COOPERATIVE COMPLIANCE.—The Secretary shall establish a State Healthcare Compliance Incentive Program that provides: (i) Enhanced federal funding for states that fully comply with the requirements of this Act; (ii) Technical assistance grants to help states align their healthcare regulations with federal standards; and (iii) Innovation grants for states that develop model programs that advance the objectives of this Act. (B) FUNDING ADJUSTMENTS.—If the Secretary determines that a state is engaged in a persistent pattern of non-compliance that substantially impedes residents’ access to healthcare services covered under this Act, after notice and opportunity for correction, the Secretary may: (i) Withhold up to 10 percent of discretionary federal healthcare funding to the state until compliance is achieved; and (ii) Redirect such funding to ensure that residents of the state have access to all healthcare services covered under this Act through direct federal provision if necessary. (C) ESSENTIAL SERVICES PROTECTION.—Any funding adjustment under subparagraph (B) shall not affect funding for: (i) Services directly provided to individual residents; (ii) Public health emergency response; or (iii) Safety net providers serving vulnerable populations.
(d) HEALTHCARE PROVIDER PROTECTIONS.—
(1) PROFESSIONAL PRACTICE PROTECTIONS.— (A) STANDARD OF CARE DEFENSE.—Healthcare providers who provide services in accordance with the evidence-based standards of care established under this Act shall have an affirmative defense to any state civil or criminal liability when: (i) The service provided is covered under this Act; (ii) The provider acted within the scope of their professional judgment; and (iii) The service was provided in accordance with NHCP guidelines and standards. (B) LEGAL CONSULTATION.—The Secretary shall establish a Healthcare Provider Legal Consultation Service to provide guidance to healthcare providers regarding potential conflicts between state and federal requirements.
(2) LEGAL SUPPORT.— (A) FEDERAL REPRESENTATION.—The Attorney General shall establish a program to provide legal representation and support for healthcare providers who face state legal proceedings for providing services covered under this Act when: (i) The provider was acting in accordance with NHCP standards and guidelines; (ii) The proceedings arise from a conflict between state law and this Act in areas of critical federal interest; and (iii) The provider requests such representation. (B) REMOVAL OPTION.—Any civil or criminal action brought in a state court against a healthcare provider for performing services covered under this Act that implicates an area of critical federal interest may, at the request of the provider, be removed to the United States district court for the district in which the action was brought for determination of federal preemption and other federal questions.
(e) PATIENT ACCESS PROTECTION.—
(1) PATIENT BILL OF RIGHTS.— (A) ESTABLISHMENT.—The Secretary shall issue a Patient Bill of Rights that clearly identifies the healthcare services to which all residents are entitled under this Act. (B) DISTRIBUTION.—The Patient Bill of Rights shall be: (i) Published in multiple languages and accessible formats; (ii) Distributed to all healthcare facilities participating in the NHCP; and (iii) Made available through a public education campaign.
(2) ACCESS REMEDIES.— (A) ADMINISTRATIVE REMEDY.—The Secretary shall establish an expedited administrative process through which patients denied access to healthcare services covered under this Act may seek resolution, including: (i) A toll-free hotline for immediate assistance; (ii) An online complaint system; and (iii) Regional patient advocates to assist individuals in accessing care. (B) JUDICIAL REMEDY.—Any individual who is denied access to healthcare services covered under this Act due to a conflict between state law and this Act may bring a civil action in an appropriate United States district court. (C) RELIEF.—In a successful action under subparagraph (B), the court may award: (i) Declaratory and injunctive relief to ensure access to services; (ii) Actual damages for any harm suffered due to delayed or denied care; (iii) Reasonable attorney’s fees and costs; and (iv) Expedited consideration when necessary to prevent irreparable harm.
(f) CONSTRUCTION.—Each provision of this section shall be construed to preserve maximum state authority consistent with the fundamental federal interest in ensuring access to healthcare services covered under this Act.
Back to Table of ContentsSECTION 25. REGULATIONS.
The Secretary shall promulgate such regulations as may be necessary to implement the provisions of this Act.
Back to Table of ContentsSECTION 26. SEVERABILITY.
(a) IN GENERAL.—If any provision of this Act or the application of such provision to any person or circumstance is held to be unconstitutional or otherwise invalid, the remainder of this Act, and the application of the provisions of such to any person or circumstance, shall not be affected thereby.
(b) APPLICATION TO PARTS OF PROVISIONS.—If any provision of this Act or the application thereof to any person or circumstance is held invalid, the application of such provision to other persons or circumstances, and the remainder of this Act, shall not be affected thereby.
(c) INTENTION OF CONGRESS.—It is the intent of Congress that the provisions of this Act are severable. If any provision of this Act, or any application of such provision to any person or circumstance, is found to be unconstitutional or otherwise invalid, such finding:
(1) Shall not disturb or affect the remaining portions of this Act that can be given effect without the invalid provision or application; and
(2) Shall not be construed to invalidate the application of the provision in question to any other person or circumstances to which it may lawfully be applied.
(d) PRESERVATION OF COVERED BENEFITS.—If any provision of this Act relating to covered benefits under Section 5 is held invalid, it is the express intent of Congress that the remaining covered benefits continue in effect to the maximum extent permitted by law. The invalidation of any specific benefit category shall not be construed to affect the availability of other benefit categories.
(e) SEVERABILITY OF FUNDING PROVISIONS.—If any provision of Section 22 of this Act relating to funding is held invalid, such holding shall not affect the remainder of this Act. Congress declares that it would have enacted the remaining provisions of this Act regardless of whether any funding provisions had been included.
(f) JUDICIAL CONSTRUCTION.—In the event a court of competent jurisdiction finds any provision of this Act or the application thereof to be invalid, the court shall endeavor to limit the scope of such decision to the feature or application that the court finds to be inconsistent with the Constitution or otherwise invalid.
Back to Table of ContentsSECTION 27. EFFECTIVE DATE.
This Act shall take effect on the date of enactment, with full program implementation to be completed within the three-year transition period as specified in Section 23.
Back to Table of ContentsSECTION 28. ERISA AMENDMENTS AND TRANSITION.
(a) AMENDMENTS TO ERISA.—
(1) IN GENERAL.—The Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by adding at the end of title I the following new part:
“PART 8—TRANSITION TO NATIONAL HEALTH CARE PROGRAM
“SEC. 801. RELATIONSHIP TO NATIONAL HEALTH CARE PROGRAM.
“(a) IN GENERAL.—Beginning on the effective date of the American Health Care Freedom Act, this Act shall not apply to any group health plan or health insurance coverage to the extent that such plan or coverage provides benefits that are covered under the National Health Care Program established under such Act.
“(b) TRANSITION PERIOD.—During the three-year transition period described in section 23 of the American Health Care Freedom Act: “(1) CONTINUATION OF PLANS.—Group health plans may continue to provide benefits that will ultimately be covered by the National Health Care Program. “(2) GRADUAL TRANSITION.—Plan sponsors shall, in accordance with regulations prescribed by the Secretary of Labor in consultation with the Secretary of Health and Human Services, modify their plans to: “(A) In Year 1, identify benefits that will transition to the National Health Care Program; “(B) In Year 2, coordinate the delivery of services with the National Health Care Program for benefits that have been transitioned; and “(C) In Year 3, eliminate any remaining duplicate coverage. “(3) NOTIFICATION REQUIREMENTS.—Plan sponsors shall provide participants and beneficiaries with clear notifications about: “(A) Which benefits are transitioning to the National Health Care Program and when; “(B) How to access services under the National Health Care Program; and “(C) Any changes to premiums, contributions, or cost-sharing resulting from the transition.
“(c) SUPPLEMENTAL BENEFITS.—Nothing in the American Health Care Freedom Act shall be construed to prohibit an employee welfare benefit plan from providing supplemental benefits that do not duplicate benefits provided under the National Health Care Program, including: “(1) Additional services not covered under the National Health Care Program; “(2) Coverage for services provided by healthcare professionals who do not participate in the National Health Care Program; and “(3) Coverage for services when traveling outside the United States.
“(d) CONTINUATION OF SAVINGS ACCOUNTS.—Health savings accounts, flexible spending arrangements, health reimbursement arrangements, and other similar accounts established under this Act may continue to be used for: “(1) Payment of premiums or cost-sharing for supplemental benefits; “(2) Payment for healthcare services not covered by the National Health Care Program; and “(3) Payment for qualified medical expenses as defined in section 223(d)(2) of the Internal Revenue Code of 1986.
“SEC. 802. PREEMPTION.
“(a) SUPERSEDING PROVISIONS.—The provisions of the American Health Care Freedom Act shall supersede any and all State laws insofar as they relate to any benefits covered under the National Health Care Program established under such Act.
“(b) CONTINUATION OF ERISA PREEMPTION.—The provisions of sections 514 and 515 of this Act shall continue to apply with respect to supplemental benefits and other employee welfare benefit plans not covered under the National Health Care Program.”
(2) CONFORMING AMENDMENTS.— (A) Section 514 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1144) is amended by adding at the end the following: “(f) SPECIAL RULE FOR NATIONAL HEALTH CARE PROGRAM.—Notwithstanding any other provision of this section, the provisions of part 8 shall supersede any and all State laws and applicable Federal laws as provided in such part.” (B) The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 is amended by adding at the end of the items relating to title I the following:
“PART 8—TRANSITION TO NATIONAL HEALTH CARE PROGRAM “Sec. 801. Relationship to National Health Care Program. “Sec. 802. Preemption.”
(b) MULTI-STATE EMPLOYER PROVISIONS.—
(1) IN GENERAL.—The Secretary of Labor, in consultation with the Secretary, shall establish a Multi-State Employer Transition Program to: (A) Provide technical assistance to multi-state employers in transitioning their benefit plans to comply with this Act; (B) Develop standardized procedures for the orderly transition of employees across state lines during the implementation of the NHCP; and (C) Ensure continuity of care for employees who frequently transfer between states.
(2) STREAMLINED ADMINISTRATION.—The Secretary and the Secretary of Labor shall jointly develop processes to: (A) Minimize administrative burdens on multi-state employers during the transition period; (B) Facilitate data sharing between employer benefit systems and the NHCP; and (C) Create a unified reporting system for employers that eliminates duplicate reporting requirements.
(c) FIDUCIARY RESPONSIBILITY DURING TRANSITION.—
(1) SAFE HARBOR.—Fiduciaries of employee benefit plans shall be deemed to be in compliance with their fiduciary responsibilities under the Employee Retirement Income Security Act of 1974 with respect to actions taken to implement the transition to the NHCP if they: (A) Act in accordance with the regulations promulgated under this section; (B) Provide timely and accurate information to plan participants about the transition; and (C) Work in good faith to minimize disruption to participants’ access to healthcare services.
(2) CONTINUED PROTECTION.—The fiduciary provisions of the Employee Retirement Income Security Act of 1974 shall continue to apply to any supplemental benefits or health-related benefits that remain under employer-sponsored plans after full implementation of the NHCP.
(d) COLLECTIVE BARGAINING AGREEMENTS.—
(1) PRESERVATION OF BENEFITS.—Where an employee benefit plan provides benefits pursuant to a collective bargaining agreement, nothing in this Act shall supersede such agreement until the date on which the last of the collective bargaining agreements relating to the plan terminates.
(2) NOTIFICATION AND BARGAINING.—Employers with collectively bargained plans shall: (A) Notify their bargaining partners of changes required by this Act; (B) Upon request, engage in bargaining over the effects of the transition to the NHCP; and (C) Work with employee representatives to ensure a smooth transition of benefits.
(3) REALLOCATION OF CONTRIBUTIONS.—The Secretary of Labor shall issue guidance to assist employers and labor organizations in negotiating the reallocation of amounts previously designated for health benefits to other employee benefits or compensation.
Back to Table of ContentsSECTION 29. RELATIONSHIP TO OTHER FEDERAL HEALTHCARE LAWS.
(a) GENERAL PRINCIPLES.—
(1) INTEGRATION OF FEDERAL HEALTHCARE PROGRAMS.—All federal programs that provide healthcare services, coverage, or benefits as of the date of enactment of this Act shall be integrated into the NHCP in accordance with this section.
(2) SUPERSEDING AND REPEALING PROVISIONS.— (A) GENERAL RULE.—Except as otherwise provided in this section, the provisions of this Act shall supersede any and all Federal statutes insofar as they: (i) Provide for healthcare coverage or benefits that duplicate those provided under the NHCP; (ii) Establish separate administrative structures for the delivery of healthcare services now unified under the NHCP; or (iii) Authorize appropriations for programs and functions terminated by this Act. (B) CONTINUATION OF STANDARDS.—Where this Act supersedes or repeals provisions of other Federal laws, any standards of quality, access, or privacy provided under such laws that exceed the standards established under this Act shall be incorporated into the regulations implementing this Act. (C) COORDINATION OF IMPLEMENTATION.—The Secretary shall consult with the heads of other Federal departments and agencies to ensure orderly transition of healthcare functions to the NHCP while ensuring continuity of care.
(3) PRIVACY STANDARDS.— (A) MINIMUM REQUIREMENTS.—The privacy and security protections established under this Act shall, at a minimum, provide privacy and security standards for protected health information that are equivalent to, or more stringent than, the standards provided under: (i) The Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder; (ii) The Health Information Technology for Economic and Clinical Health Act and the regulations promulgated thereunder; and (iii) The privacy protections for substance use disorder records under 42 U.S.C. § 290dd-2 and the regulations promulgated thereunder. (B) HARMONIZATION OF STANDARDS.—Within 1 year after the date of enactment of this Act, the Secretary shall issue regulations harmonizing the privacy standards under this Act with existing Federal privacy protections, adopting the most protective standard where differences exist. (C) PRIVACY IMPACT ANALYSIS.—Before integrating any federal healthcare program into the NHCP, the Secretary shall conduct a privacy impact analysis and implement any additional safeguards needed to protect patient information during and after the transition.
(b) MEDICARE AND MEDICAID.—
(1) TERMINATION AND TRANSITION.— (A) TERMINATION.—Titles XVIII and XIX of the Social Security Act are repealed effective on the date that is 3 years after the date of enactment of this Act. (B) TRANSITION.—During the three-year implementation period described in section 23: (i) In Year 1, the Secretary shall establish coordination procedures between Medicare, Medicaid, and the NHCP; (ii) In Year 2, all Medicare beneficiaries and Medicaid enrollees shall be automatically enrolled in the NHCP while maintaining their existing coverage; and (iii) In Year 3, all healthcare services previously covered under Medicare and Medicaid shall be provided exclusively through the NHCP.
(2) PRESERVATION OF MEDICARE TRUST FUNDS.— (A) TRANSFER OF FUNDS.—The Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund shall continue in existence until all funds have been transferred to the NHCP Trust Fund established under section 22 and all outstanding obligations have been met. (B) TRUSTEE REPORT.—Not later than January 1 of Year 3 of implementation, the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund shall submit to Congress a report on the transfer of assets and obligations to the NHCP Trust Fund.
(3) STATE MEDICAID TRANSITION.— (A) MAINTENANCE OF EFFORT.—During the three-year implementation period, states shall maintain their Medicaid programs and expenditure levels as required under section 1902(gg) of the Social Security Act. (B) FEDERAL ASSUMPTION OF COSTS.—Beginning in Year 2 of implementation, the Federal Government shall incrementally assume state Medicaid costs, with full assumption by the end of Year 3. (C) STATE MEDICAID WORKFORCE.—States shall receive funding for transitioning their Medicaid workforce to the NHCP or other state functions, with priority consideration for employment under the NHCP.
(4) CONTINUATION OF DEMONSTRATION PROJECTS.—The Secretary may continue Medicare and Medicaid demonstration projects that improve quality or reduce costs for a maximum of 5 years after the effective date of this Act, and may incorporate successful models into the NHCP.
(c) VETERANS HEALTH ADMINISTRATION.—
(1) INTEGRATION WITH SPECIALIZED SERVICES.— (A) TRANSFER OF FUNCTIONS.—The functions of the Veterans Health Administration shall be transferred to the Department of Health and Human Services to be administered as a specialized service within the NHCP, effective 3 years after the date of enactment of this Act. (B) MAINTENANCE OF VHA FACILITIES.—All Department of Veterans Affairs medical centers, community-based outpatient clinics, and other healthcare facilities shall be maintained and incorporated into the NHCP as specialized facilities with expertise in veterans’ healthcare needs. (C) VETERAN-SPECIFIC SERVICES.—The NHCP shall maintain and expand specialized services for veterans, including: (i) Combat-related trauma and injury care; (ii) Post-traumatic stress disorder treatment; (iii) Prosthetics and rehabilitation for service-connected injuries; (iv) Agent Orange, burn pit, and other toxic exposure treatment; and (v) Other specialized services required by veterans.
(2) PERSONNEL TRANSITION.— (A) TRANSFER OF PERSONNEL.—All personnel employed by the Veterans Health Administration on the date of transfer shall be transferred to the Department of Health and Human Services for employment under the NHCP. (B) PRESERVATION OF PAY AND BENEFITS.—Transferred personnel shall maintain their seniority, pay, and benefits at a level not less than what they received prior to transfer. (C) SPECIALIZED TRAINING.—The NHCP shall maintain and expand specialized training programs for healthcare professionals in veterans’ healthcare needs.
(3) CONGRESSIONAL REPORTING.—The Secretary, in consultation with veterans service organizations, shall submit annual reports to Congress on the status of veterans’ healthcare under the NHCP for the first 5 years after integration.
(d) MILITARY HEALTH SYSTEM AND TRICARE.—
(1) ACTIVE DUTY MILITARY PERSONNEL.— (A) SEPARATE ADMINISTRATION.—Healthcare services for active duty military personnel shall continue to be administered by the Department of Defense to ensure operational readiness and mission-specific capabilities. (B) BENEFIT PARITY.—Notwithstanding separate administration, healthcare services provided to active duty military personnel shall: (i) Include, at minimum, all benefits and services covered under the NHCP; (ii) Meet or exceed all quality and access standards established under the NHCP; and (iii) Utilize the same formularies, medical necessity standards, and clinical practice guidelines as the NHCP, with additional standards as needed for military-specific requirements. (C) COORDINATION.—The Secretary of Defense and the Secretary shall establish coordination mechanisms between the military health system and the NHCP to ensure seamless care when active duty personnel transition to veteran status. (D) ANNUAL EQUIVALENCE CERTIFICATION.—The Secretary of Defense shall annually certify to Congress that the healthcare services provided to active duty military personnel are at least equivalent to those provided under the NHCP, with documentation of any variations necessary for military operational requirements.
(2) MILITARY RETIREES AND DEPENDENTS.— (A) TRANSITION FROM TRICARE.—Within 3 years after the date of enactment of this Act, all military retirees and dependents enrolled in TRICARE shall transition to coverage under the NHCP. (B) OVERSEAS COVERAGE.— (i) The Secretary, in consultation with the Secretary of Defense, shall establish procedures for providing healthcare coverage to military dependents residing overseas. (ii) Such coverage shall include all benefits provided under the NHCP, adapted as necessary for overseas delivery. (iii) The Department of Defense shall maintain military treatment facilities overseas to serve military dependents with the full range of NHCP benefits. (C) TERMINATION OF TRICARE.—TRICARE shall terminate 3 years after the date of enactment of this Act, except for components necessary for active duty personnel deployed overseas.
(3) MILITARY TREATMENT FACILITIES.— (A) TRANSFER OF CIVILIAN CARE FACILITIES.—Military treatment facilities primarily serving retirees and dependents shall be transferred to the NHCP. (B) JOINT OPERATION.— (i) Military treatment facilities serving both active duty personnel and other beneficiaries may be operated jointly by the Department of Defense and the NHCP. (ii) Joint facilities shall provide the full range of NHCP benefits to all eligible individuals. (iii) The Secretary of Defense and the Secretary shall establish shared staffing models, unified electronic health records, and integrated quality monitoring systems for jointly operated facilities.
(4) UNIFORMED SERVICES SPECIFIC NEEDS.— (A) SPECIALIZED MILITARY MEDICAL CAPABILITIES.—The Department of Defense shall maintain specialized military medical capabilities necessary for: (i) Combat casualty care; (ii) Deployment readiness; (iii) Aerospace medicine; (iv) Dive medicine; (v) Chemical, biological, radiological, and nuclear response; and (vi) Other specialized capabilities required for military operations. (B) RESEARCH INTEGRATION.—Military medical research shall be coordinated with NHCP research initiatives, with particular focus on: (i) Combat injury treatment and rehabilitation; (ii) Traumatic brain injury and post-traumatic stress disorder; (iii) Environmental exposure health effects; and (iv) Other military-specific health concerns. (C) PUBLIC HEALTH EMERGENCY COORDINATION.—The Secretary of Defense and the Secretary shall establish protocols for coordinated response to public health emergencies, including integration of Military Health System capabilities with the NHCP.
(e) INDIAN HEALTH SERVICE.—
(1) PRESERVATION OF OBLIGATIONS.— (A) FEDERAL TRUST RESPONSIBILITY.—Nothing in this Act shall be construed to diminish or alter the federal trust responsibility for providing healthcare to American Indians and Alaska Natives. (B) MAINTENANCE OF FACILITIES.—All Indian Health Service facilities shall be maintained and incorporated into the NHCP as specialized facilities with expertise in the healthcare needs of American Indians and Alaska Natives.
(2) TRIBAL SELF-DETERMINATION.— (A) PRESERVATION OF AUTHORITY.—Tribes and tribal organizations that operate health programs through self-determination contracts or self-governance compacts shall retain the authority to administer healthcare services under the NHCP. (B) INCREASED FUNDING.—Funding for tribally operated health programs shall be increased to the per capita level available to all NHCP beneficiaries, plus additional amounts as needed for remote and underserved areas. (C) TECHNICAL ASSISTANCE.—The Secretary shall provide technical assistance to tribes and tribal organizations to facilitate their participation in the NHCP while maintaining tribal governance.
(3) INDIAN HEALTH SERVICE TRANSITION.— (A) TRANSFER OF FUNCTIONS.—The functions of the Indian Health Service shall be transferred to the Department of Health and Human Services to be administered as a specialized service within the NHCP, effective 3 years after the date of enactment of this Act. (B) PERSONNEL TRANSITION.—All personnel employed by the Indian Health Service on the date of transfer shall be transferred to the Department of Health and Human Services for employment under the NHCP, maintaining their seniority, pay, and benefits. (C) TRIBAL CONSULTATION.—All aspects of the transition and integration shall be developed in consultation with tribes and tribal organizations in accordance with Executive Order 13175 (25 U.S.C. 5301 note).
(f) COMMUNITY HEALTH CENTERS AND SAFETY NET PROVIDERS.—
(1) FEDERALLY QUALIFIED HEALTH CENTERS.— (A) INTEGRATION.—All Federally Qualified Health Centers (FQHCs) shall be integrated into the NHCP as essential community providers. (B) MAINTENANCE OF ENHANCED FUNCTIONS.—FQHCs shall maintain their enhanced functions within the NHCP, including: (i) Comprehensive primary care services; (ii) Translation and transportation services; (iii) Case management and outreach; and (iv) Focus on medically underserved communities. (C) FUNDING.—FQHCs shall receive global budget payments that are not less than the funding they received in the year prior to enactment, adjusted annually for inflation and increased service needs.
(2) RURAL HEALTH CLINICS.— (A) INTEGRATION.—All Rural Health Clinics shall be integrated into the NHCP as essential rural providers. (B) ENHANCED PAYMENTS.—Rural Health Clinics shall receive enhanced global budget payments to ensure their sustainability in rural communities.
(3) OTHER SAFETY NET PROVIDERS.—The Secretary shall develop integration plans for other safety net providers, including: (A) Public hospitals; (B) Community mental health centers; (C) School-based health centers; and (D) Family planning clinics.
(g) AFFORDABLE CARE ACT AND RELATED LAWS.—
(1) REPEAL OF MARKET PROVISIONS.— (A) The following provisions of the Patient Protection and Affordable Care Act are repealed effective 3 years after the date of enactment of this Act: (i) Title I (except for patient protections incorporated into this Act); (ii) Title II, Subtitle A (Medicaid expansion); (iii) Title III, Subtitle E (regarding insurance reforms); (iv) Title VI (regarding insurance reforms); and (v) Title X, Subtitle A (regarding insurance reforms). (B) INTERNAL REVENUE CODE PROVISIONS.—The amendments made to the Internal Revenue Code of 1986 by the Patient Protection and Affordable Care Act relating to health insurance coverage are repealed effective 3 years after the date of enactment of this Act.
(2) PRESERVATION AND TRANSITION OF QUALITY AND DELIVERY REFORM PROVISIONS.— (A) CONTINUATION.—The following aspects of the Patient Protection and Affordable Care Act shall be continued and integrated into the NHCP: (i) The Center for Medicare and Medicaid Innovation (redesignated as the NHCP Innovation Center); (ii) The Patient-Centered Outcomes Research Institute; (iii) The National Quality Strategy and related quality measurement programs; (iv) Healthcare workforce development programs; and (v) Public health and prevention initiatives. (B) TRANSITION OF INNOVATION MODELS.—Successful delivery and payment models developed through the Center for Medicare and Medicaid Innovation shall be evaluated for adoption within the NHCP.
(3) STATE EXCHANGE TRANSITION.— (A) TERMINATION OF FUNCTIONS.—State Health Insurance Exchanges established under the Patient Protection and Affordable Care Act shall cease operations as insurance marketplaces 3 years after the date of enactment of this Act. (B) ENROLLMENT FUNCTIONALITY.—The Secretary may utilize Exchange technology platforms for NHCP enrollment functions if cost-effective. (C) PERSONNEL TRANSITION.—State Exchange personnel shall receive priority consideration for employment with the NHCP.
(h) HEALTH INFORMATION TECHNOLOGY LAWS.—
(1) INTEGRATION OF HITECH PROVISIONS.— (A) INCORPORATION.—The provisions of the Health Information Technology for Economic and Clinical Health Act that promote the meaningful use of electronic health records shall be incorporated into the NHCP, with modifications as necessary to reflect the unified healthcare system. (B) UNIFORM STANDARDS.—The Secretary shall establish uniform national standards for electronic health records and health information exchange under the NHCP. (C) INTEROPERABILITY REQUIREMENTS.—All healthcare providers under the NHCP shall be required to maintain interoperable electronic health records that meet standards set by the Secretary. (D) PRIVACY PROTECTIONS.—Privacy protections for electronic health records under the NHCP shall meet or exceed those established under the Health Information Technology for Economic and Clinical Health Act.
(2) HEALTH INFORMATION EXCHANGES.— (A) NATIONAL FRAMEWORK.—The Secretary shall establish a national framework for health information exchange under the NHCP, building upon existing regional and state health information exchanges. (B) UNIVERSAL PATIENT IDENTIFIER.—The Secretary shall develop a universal patient identifier system with robust privacy and security protections to facilitate accurate health information exchange.
(i) EMERGENCY MEDICAL TREATMENT AND LABOR ACT.—
(1) INCORPORATION.—The requirements of the Emergency Medical Treatment and Labor Act (EMTALA) shall be incorporated into the conditions of participation for healthcare facilities under the NHCP.
(2) EXPANSION.—The Secretary shall expand emergency care protections beyond hospital emergency departments to include urgent care facilities and other acute care settings.
(3) ENHANCED ENFORCEMENT.—The Secretary shall maintain and enhance enforcement mechanisms to prevent patient dumping or discrimination in emergency care settings.
(j) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM.—
(1) TERMINATION.—The Federal Employees Health Benefits Program under chapter 89 of title 5, United States Code, is terminated effective 3 years after the date of enactment of this Act.
(2) TRANSITION.— (A) ENROLLMENT.—All enrollees in the Federal Employees Health Benefits Program shall be automatically enrolled in the NHCP. (B) CONVERSION OF EMPLOYER CONTRIBUTIONS.—Federal employer contributions previously made to the Federal Employees Health Benefits Program shall be converted to employee compensation as provided in section 20 of this Act.
(3) OFFICE OF PERSONNEL MANAGEMENT.— (A) TRANSFER OF FUNCTIONS.—Healthcare-related functions of the Office of Personnel Management shall be transferred to the Department of Health and Human Services. (B) PERSONNEL TRANSITION.—Personnel employed by the Office of Personnel Management whose primary duties relate to the Federal Employees Health Benefits Program shall be transferred to the Department of Health and Human Services for employment under the NHCP.
(k) OTHER HEALTHCARE PROGRAMS.—
(1) INTEGRATION OF ADDITIONAL PROGRAMS.—The following additional federal healthcare programs shall be integrated into the NHCP: (A) The National Health Service Corps; (B) The Maternal and Child Health Block Grant program; (C) The Family Planning program under Title X of the Public Health Service Act; (D) The health components of the Head Start program; (E) Healthcare services provided by the Federal Bureau of Prisons; (F) Healthcare services provided by the Immigration and Customs Enforcement Health Service Corps; and (G) School-based health centers funded through the Health Resources and Services Administration.
(2) TIMELINE FOR INTEGRATION.—The Secretary shall develop a timeline for integrating each program identified in paragraph (1) into the NHCP, with full integration to be completed within 3 years after the date of enactment of this Act.
(3) CONTINUATION OF TARGETED PROGRAMS.—Where federal healthcare programs serve unique populations or provide specialized services not otherwise specifically addressed by the NHCP, the Secretary shall ensure that those targeted services continue under the NHCP.
(l) FEDERAL HEALTHCARE INTEGRATION COUNCIL.—
(1) ESTABLISHMENT.—There is established a Federal Healthcare Integration Council (in this subsection referred to as the “Council”) to coordinate the integration of existing federal healthcare programs into the NHCP.
(2) COMPOSITION.—The Council shall be composed of: (A) The Secretary, who shall serve as Chair; (B) The Secretary of Defense; (C) The Secretary of Veterans Affairs; (D) The Secretary of the Treasury; (E) The Director of the Office of Personnel Management; (F) The Commissioner of Social Security; (G) The Director of the Indian Health Service; (H) The Administrator of the Centers for Medicare & Medicaid Services; (I) The National Coordinator for Health Information Technology; and (J) Such other federal officials as the Secretary determines appropriate.
(3) DUTIES.—The Council shall: (A) Develop a coordinated plan for transitioning federal healthcare programs to the NHCP; (B) Identify statutory and regulatory barriers to integration and recommend solutions; (C) Ensure continuity of care during transitions; (D) Coordinate budgetary and financial transfers; (E) Facilitate data sharing and system interoperability; (F) Recommend harmonized policies and standards; and (G) Submit quarterly reports to Congress on transition progress.
(4) WORKING GROUPS.—The Council may establish working groups focused on specific aspects of integration, including: (A) A Privacy and Data Security Working Group; (B) A Facilities and Capital Assets Working Group; (C) A Personnel Transition Working Group; (D) A Budget and Financing Working Group; and (E) Such other working groups as the Council determines necessary.
(5) TERMINATION.—The Council shall terminate 6 months after the completion of the transition to the NHCP, or 5 years after the date of enactment of this Act, whichever is later.
(m) REGULATIONS.—The Secretary shall promulgate regulations implementing this section not later than 1 year after the date of enactment of this Act.
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