H.R. 4235 — National Children's Health Care Act of 1992

 
HR 4235 IH
102d CONGRESS
2d Session
 H. R. 4235
To provide for comprehensive health care for pregnant women and children
under 7 years of age through a government insurance program.
IN THE HOUSE OF REPRESENTATIVES
February 18, 1992
Mr. OLIN introduced the following bill; which was referred jointly to the
Committees on Energy and Commerce and Ways and Means
A BILL
To provide for comprehensive health care for pregnant women and children
under 7 years of age through a government insurance program.
  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 `National Children's Health Care Act of 1992'.
TITLE I--FINDINGS
SEC. 101. FINDINGS.
  Congress finds the following:
  (1) Children are the most vulnerable segment of our population, but are the
  least able to advocate for themselves. They are the citizens of the future.
  (2)(A) More than 25 percent of American children live in poverty.
  (B) Only half of Medicaid eligible children actually receive medical
  services.
  (C) Medicaid rules are complex and benefits are uneven, subject to various
  State regulations.
  (D) Health care services under Medicaid are often fragmented and
  crisis-based, leading to wasteful duplication and inappropriate use of
  emergency rooms.
  (E) Determining Medicaid eligibility is demeaning to the family and costly
  and time consuming for health care providers.
  (F) Losing Medicaid eligibility is threatening to the family and acts as
  a negative incentive to finding employment.
  (3)(A) Many children over the poverty level are uninsured.
  (B) Health insurance is not part of their working parents' benefits.
  (4)(A) Many insured children are underinsured.
  (B) Regular check-ups, immunizations, and other preventive measures are
  not covered by many health insurance programs.
  (C) Costs of preventive shots and prescription drugs have increased greatly.
  (5) According to a January 1992 study released by the Children's Defense
  Fund, 40 percent of American children lack employer-provided health
  insurance. The study predicted that 43 percent of those who do have
  employer-provided health insurance will suffer a period during which
  they are not covered by the end of 1992. The numbers are much higher for
  minority children.
  (6) Investment in a comprehensive health program for children would
  minimize administrative costs and would save money in the long run. Lack
  of immunization and fragmented episodic health care delivery are costly
  to our society.
  (7) Comprehensive health care for children and pregnant women is workable
  and affordable now. It would get children off to a healthy start.
  (8) Approximately 35 percent of pregnant women (and 50 percent of black
  pregnant women) receive minimal or no prenatal care, especially in inner
  cities and rural areas. Women who do not receive routine prenatal care
  are approximately three times more likely to deliver low birth weight
  infants. Lack of prenatal care leads to high infant mortality, low birth
  weight, and a high incidence of preventable birth defects and retardation.
  (9) A child born in Japan, Finland, Hong Kong, Ireland, Australia, Canada,
  Singapore, or any of 12 other industrialized nations has a better chance of
  surviving his or her first year than a child born in the United States. A
  child born in Czechoslovakia or Bulgaria has a better chance of celebrating
  its first birthday than a black child born in America's urban areas or the
  rural South. From 1989 to 2000, 520,000 infants will die if the United
  States infant mortality rate continues unchecked. This is more than the
  total number of battlefield deaths of American forces in World Wars I and
  II, Korea, and Vietnam combined. Low birth weight (5.5 pounds or less) is
  a leading factor contributing to infant mortality. Since 1980, no progress
  has been made in reducing the overall rate at which babies are born too
  soon or too small.
  (10) Investment in comprehensive prenatal and maternal care would reduce
  the expenditures for neonatal intensive care of low birth weight and/or
  high risk infants (which average over $20,000 per child at a cost of $1.5
  billion a year). 11,000 low birth-weight babies are born in the United
  States each year with long term disabilities resulting from their fragile
  condition. The high cost of medical and remedial care continues for these
  children with life-long disabilities.
TITLE II--CHILDREN'S HEALTH CARE PROGRAM
SEC. 201. ESTABLISHMENT OF NATIONAL CHILDREN'S HEALTH CARE ADMINISTRATION
AND PROGRAM.
  (a) IN GENERAL- There is established within the Department of Health and
  Human Services a National Children's Health Care Administration to be headed
  by an Administrator (in this title referred to as the `Administration'
  and `Administrator', respectively), appointed by the President by and with
  the advice and consent of the Senate.
  (b) ESTABLISHMENT OF PROGRAM- The Administrator shall establish and operate
  in accordance with this title a program (in this title referred to as the
  `Program') of health care for pregnant women and children under 7 years
  of age.
  (c) ADVISORY COMMISSION- The Administrator shall establish an advisory
  commission, composed of physicians, nurses, hospital administrators, public
  health administrators, dental care providers, and parents of covered
  children, to advise the Administrator concerning the establishment of
  payment rates and other aspects of the Program.
  (d) PAYMENT RATES-
  (1) IN GENERAL- The Administrator shall establish payment rates for
  covered health services that are fully adequate to compensate providers
  reasonably for the provision of such services. The Program shall not
  impose any limitation on the amount, duration, or scope for medically
  necessary services and does not impose any deductibles, coinsurance,
  or other cost-sharing with respect to such services.
  (2) PREVENTION OF LOSS- In establishing such rates, the Administrator
  shall attempt to ensure that--
  (A) physicians and hospitals will not suffer a net loss of income as a
  result of implementation of the Program;
  (B) groups of physicians, or physicians within particular specialties,
  will not suffer a net loss of income as a result of implementation of the
  Program; and
  (C) providers within geographic regions will not suffer a net loss of
  income as a result of implementation of the Program.
SEC. 202. ENTITLEMENT.
  (a) IN GENERAL- Each eligible pregnant woman and child is entitled to
  health benefits under the Program.
  (b) ENROLLMENT- The Administrator shall provide for and permit enrollment
  of eligible pregnant women and children under the Program through local
  health departments. In addition, the Administrator shall seek to provide
  for the issuance of cards indicating entitlement to benefits under the
  Program to mothers of new borns at the time of birth in a hospital and to
  pregnant women.
  (c) ELIGIBLE PREGNANT WOMAN AND CHILD DEFINED- In this title, the term
  `eligible pregnant woman and child' means an individual who--
  (1) is a pregnant woman or is a child under 7 years of age, and
  (2) is (A) a citizen or national of the United States, (B) an alien
  lawfully admitted for permanent residence, or (C) an alien otherwise
  residing permanently in the United States under color of law.
SEC. 203. COVERED HEALTH SERVICES.
  (a) HEALTH SERVICES-
  (1) IN GENERAL- Except as provided in the succeeding provisions of this
  title, health benefits under this title shall consist of payment in
  accordance with this title for the following health services:
  (A) Preventive care services (as defined in subsection (b)).
  (B) Major medical services (as defined in subsection (c)).
  (C) Child extended medical services (as defined in subsection (d)).
  (D) Outreach services provided under subsection (e).
  (2) COVERED HEALTH SERVICES DEFINED- In this title, the term `covered
  health services' means the health services described in paragraph (1).
  (3) STANDARDS- The Administrator shall establish standards with respect
  to covered health services.
  (b) PREVENTIVE CARE SERVICES- In this title, the term `preventive care
  services' means the following items and services:
  (1) Child preventive care, including--
  (A) routine office visits and checkups;
  (B) routine immunizations;
  (C) routine laboratory tests;
  (D) periodic vision and hearing screenings;
  (E) periodic speech, language, and developmental screenings; and
  (F) preventive dental care, including oral examinations, cleaning,
  fluoridation, protective sealants, and dental hygiene instruction.
  (2) Prenatal care, including--
  (A) periodic visits;
  (B) tests;
  (C) educational materials; and
  (D) medications as prescribed.
  (c) MAJOR MEDICAL SERVICES- In this title, the term `major medical services'
  means the following items and services (to the extent they are not preventive
  care services):
  (1) Child major medical care, including--
  (A) inpatient and outpatient hospital services;
  (B) physicians' services, including services of the primary physician and
  referral to specialists;
  (C) provision of hearing aids, eyeglasses, or prosthetic devices;
  (D) professional services of certified physician assistants, nurse
  practitioners, and other health professionals (to the extent authorized
  under State law);
  (E) diagnostic tests (including laboratory tests);
  (F) ambulance transportation;
  (G) short-term home health services;
  (H) medical and surgical supplies and durable medical equipment;
  (I) prescription drugs, insulin, and medically recommended nutritional
  supplements; and
  (J) dental services, including extractions, fillings, and other necessary
  dental treatments.
  (2) Prenatal major medical care, including--
  (A) hospital care, including delivery;
  (B) care by physicians, nurse midwives, and anesthesiologists;
  (C) medications;
  (D) supplies;
  (E) care for mother and child for a normal delivery and for Caesarean
  delivery;
  (F) treatment for complications of pregnancy; and
  (G) post-natal visits as recommended by the physician.
  (d) CHILD EXTENDED MEDICAL SERVICES- In this title, the term `child extended
  medical services' means the following items and services (to the extent
  they are not major medical services):
  (1) Treatment of mental illness and substance abuse treatment.
  (2) Treatment of developmental and learning disabilities.
  (3) Speech, occupational, and physical therapy.
  (4) Nutrition counseling.
  (e) OUTREACH SERVICES-
  (1) ESTABLISHMENT OF OUTREACH SYSTEM- Each State shall establish an outreach
  system to assure, through outreach services, that eligible pregnant women
  and children have access to covered health services. This system shall be
  a community-based effort, using care coordinators to link patients up with
  physicians, nurses, social workers, community health centers, and other
  community agencies, with the goal of working together to help families
  gain access to the appropriate health services. A care coordinator shall
  be assigned to families and pregnant women who may benefit from outreach
  services.
  (2) OUTREACH SERVICES DEFINED- In this title, the term `outreach services'
  include the following services provided under an outreach system established
  by each State:
  (A) When children or pregnant women are issued a health card, a public
  health nurse will inform them about the covered health services provided
  under the Program.
  (B) If needed, assistance will be provided to eligible pregnant women and
  children to find a primary care physician.
  (C) Help in finding a physician, dentist, or pharmacy near the home,
  transportation assistance, assistance in making and keeping appointments,
  and help in following up on treatments and medications.
  (D) Home visits, infant and child care education, nutrition counseling,
  and other supportive services.
  (3) GOAL OF OUTREACH PROGRAM- The goal of the outreach program under this
  subsection will be to encourage independence and to develop parental skills
  and responsibilities.
  (4) REIMBURSEMENT OF STATE EXPENDITURES- State health department
  expenditures for the services of care coordinators shall be reimbursed by
  the Administration if established guidelines are followed.
  (f) Freedom of Choice of Providers and Practitioners-
  (1) IN GENERAL- Any individual entitled to benefits under the Program with
  respect to covered health services may obtain benefits for such services
  provided by any provider or practitioner who is qualified to provide
  (and receive payment with respect to) such services under the Program.
  (2) TREATMENT OF ENROLLMENT WITH HEALTH MAINTENANCE ORGANIZATIONS AND
  COMPETITIVE MEDICAL PLANS- Nothing in paragraph (1) shall be construed to
  prohibit a health maintenance organization or competitive medical plan from
  limiting, under a contract entered into pursuant to section 205, the number
  of providers or practitioners for which benefits for services are paid.
  (g) MANDATORY ASSIGNMENT-
  (1) IN GENERAL- No person who provides services for which payment may be
  made under the Program may impose a charge for the services which exceeds
  the payment rate recognized with respect to the services under this title.
  (2) SANCTIONS-
  (A) IN GENERAL- The Administrator may impose sanctions described in
  subparagraph (B) for the imposition of a charge in violation of paragraph
  (1).
  (B) SANCTIONS DESCRIBED- Subject to subparagraph (C), the sanctions which
  the Administrator may apply under this subparagraph are--
  (i) excluding the provider from participation in the Program for a period
  not to exceed 5 years, in accordance with the procedures of subsections (c),
  (f), and (g) of section 1128 of the Social Security Act, or
  (ii) civil monetary penalties and assessments, in the same manner as such
  penalties and assessments are authorized under section 1128A(a) of such Act,
or both. The provisions of section 1128A (other than the first 2 sentences
of subsection (a) and other than subsection (b)) shall apply to a civil
money penalty and assessment under clause (ii) in the same manner as such
provisions apply to a penalty, assessment, or proceeding under section
1128A(a), except to the extent such provisions are inconsistent with clause
(i) or subparagraph (C).
  (C) LIMITATION- The Administrator may not exclude a provider pursuant to
  subparagraph (B)(i) if the provider is the sole community provider or sole
  source of essential specialized services in a community. The Administrator
  shall take into account access of beneficiaries to necessary services for
  which payment may be made under the Program in determining whether to bar
  a provider from participation under subparagraph (B)(i).
  (D) APPLICATION- In applying subparagraphs (B) and (C), any reference in a
  referenced provision of law to the Secretary of Health and Human Services
  is deemed a reference to the Administrator.
SEC. 204. EXCLUSIONS.
  (a) IN GENERAL- Except as provided in this section, section 1862 of the
  Social Security Act shall apply to expenses incurred for items and services
  provided under the Program in the same manner as such section applies to
  items and services provided under title XVIII of such Act.
  (b) PREVENTIVE SERVICES- In the case of preventive services provided
  consistent with the applicable periodicity schedule--
  (1) such services shall be considered to be reasonable and medically
  necessary, and
  (2) shall not be subject to exclusion through the operation of paragraph (1),
  (7), or (12) of section 1862(a) of the Social Security Act (as incorporated
  under subsection (a)).
  (c) USE OF SAME NATIONAL COVERAGE DECISION REVIEW PROCESS- The provisions
  of section 1869(b)(3) of the Social Security Act shall apply under this
  title in the same manner as they apply under title XVIII of such Act. Any
  determination under such title that, under subsection (a), would apply
  under this title shall not be subject to review under this subsection.
SEC. 205. USE OF HEALTH MAINTENANCE ORGANIZATIONS.
  The Administrator may provide for contracts with health maintenance
  organizations and other eligible organizations to provide covered health
  services to children under this title. Such contracts shall, to the extent
  not inconsistent with this title, be modeled after risk-sharing contracts
  entered into under section 1876 of the Social Security Act.
SEC. 206. EFFECTIVE DATE.
  The Program under this title shall take effect on January 1, 1993.
TITLE III--FINANCING THROUGH INCREASE IN INDIVIDUAL AND CORPORATE INCOME
TAX RATES
SEC. 301. INCREASE IN INDIVIDUAL INCOME TAX RATES.
  (a) GENERAL RULE- Section 1 of the Internal Revenue Code of 1986 (relating
  to tax imposed) is amended by striking subsections (a) through (e) and
  inserting the following:
  `(a) MARRIED INDIVIDUALS FILING JOINT RETURNS AND SURVIVING SPOUSES-
  There is hereby imposed on the taxable income of--
  `(1) every married individual (as defined in section 7703) who makes a
  single return jointly with his spouse under section 6013, and
  `(2) every surviving spouse (as defined in section 2(a)),
a tax determined in accordance with the following table:
`If taxable income is:
The tax is:
Not over $36,000
16% of taxable income.
Over $36,000 but not over $87,050
$5,760, plus 30% of the excess over $36,000.
Over $87,050
$21,075, plus 33% of the excess over $87,050.
  `(b) HEADS OF HOUSEHOLDS- There is hereby imposed on the taxable income
  of every head of a household (as defined in section 2(b)) a tax determined
  in accordance with the following table:
`If taxable income is:
The tax is:
Not over $28,900
16% of taxable income.
Over $28,900 but not over $74,650
$4,624, plus 30% of the excess over $28,900.
Over $74,650
$18,349, plus 33% of the excess over $74,650.
  `(c) UNMARRIED INDIVIDUALS (OTHER THAN SURVIVING SPOUSES AND HEADS OF
  HOUSEHOLDS)- There is hereby imposed on the taxable income of every
  individual (other than a surviving spouse as defined in section 2(a) or
  the head of a household as defined in section 2(b)) who is not a married
  individual (as defined in section 7703) a tax determined in accordance
  with the following table:
`If taxable income is:
The tax is:
Not over $21,600
16% of taxable income.
Over $21,600 but not over $52,250
$3,456, plus 30% of the excess over $21,600.
Over $52,250
$12,651, plus 33% of the excess over $52,250.
  `(d) MARRIED INDIVIDUALS FILING SEPARATE RETURNS- There is hereby imposed
  on the taxable income of every married individual (as defined in section
  7703) who does not make a single return jointly with his spouse under
  section 6013, a tax determined in accordance with the following table:
`If taxable income is:
The tax is:
Not over $18,000
16% of taxable income.
Over $18,000 but not over $43,525
$2,880, plus 30% of the excess over $18,000.
Over $43,525
$10,537.50, plus 33% of the excess over $43,525.
  `(e) ESTATES AND TRUSTS- There is hereby imposed on the taxable income of--
  `(1) every estate, and
  `(2) every trust,
taxable under this subsection a tax determined in accordance with the
following table:
`If taxable income is:
The tax is:
Not over $3,300
16% of taxable income.
Over $3,300 but not over $9,900
$528, plus 30% of the excess over $3,300.
Over $9,900
$2,508, plus 33% of the excess over $9,900.
  (b) CONFORMING AMENDMENT- Section 541 of such Code is amended by striking
  `28 percent' and inserting `33 percent'.
  (c) EFFECTIVE DATE- The amendments made by this section shall apply to
  taxable years beginning after December 31, 1991.
SEC. 302. INCREASE IN CORPORATE INCOME TAX RATES.
  (a) IN GENERAL- Subsection (b) of section 11 of the Internal Revenue Code of
  1986 (relating to tax on corporations) is amended by striking `34 percent'
  each place it appears and inserting `37 percent'.
  (b) EFFECTIVE DATE- The amendment made by this section shall apply to
  taxable years beginning after December 31, 1991.
National Children's Health Care Act of 1992

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