Section 301(b)(1) of this Act — which prohibits any board member, executive, or administrator of an institutional provider from receiving compensation from, owning stock or holding other financial investments in, or serving as a board member of any entity that contracts with or provides items or services to such provider — is hereby affirmed and strengthened. This is a conflict-of-interest and anti-self-dealing prohibition: it prevents the people who run an institution from steering its purchasing decisions toward companies in which they hold a personal financial stake. The Secretary shall promulgate rules requiring annual disclosure of all financial relationships of board members, executives, and administrators, and shall refer violations for enforcement under section 411. Nothing in section 301(b)(1) restricts the clinical compensation of physicians, surgeons, nurses, or other licensed practitioners for the direct patient care they personally provide; clinical compensation is governed separately by the compensation ceilings established under the amendments to sections 611 and 612 of this Act.

Rationale: Section 301(b)(1) as filed is a conflict-of-interest provision, not a compensation cap. This amendment makes that explicit so the provision is enforced as intended — stopping executives and administrators from self-dealing through vendors and suppliers they personally profit from — while clarifying that clinical compensation for surgeons, specialists, and nurses is addressed separately under the sections 611–612 ceilings, not here.

Section 401(c)(1) is hereby amended by striking “every fifth fiscal year” and inserting “annually”. The Comptroller General of the United States shall conduct an audit of the Department of Health and Human Services in each fiscal year following the effective date of this Act.

Rationale: A program of this scale — administering health care for the entire United States population — cannot wait five years for an audit. Annual audits ensure rapid identification of waste, fraud, and inefficiency. The cost of annual auditing is trivial relative to the program's size and is dwarfed by the savings discovered through more frequent oversight.

(a) IN GENERAL.—The Secretary shall establish and enforce minimum provider-to-population ratios for mental health and substance use disorder services in every region of the United States. The minimum standard shall be one licensed mental health provider per 1,500 residents in urban areas and one per 2,500 residents in rural areas, with parity provisions for child and adolescent specialists.

(b) WORKFORCE BUILD-OUT.—There is hereby appropriated such sums as may be necessary, but not less than $8,000,000,000 annually for the first five fiscal years, to fund tuition forgiveness, residency expansion, loan repayment, and salary support for licensed clinical social workers, psychiatric nurse practitioners, psychiatrists, psychologists, licensed marriage and family therapists, licensed mental health counselors, and certified substance use disorder counselors.

(c) ENFORCEMENT.—Regional directors shall publish quarterly reports on provider-to-population ratios in their region. Any region failing to meet the standards in subsection (a) for two consecutive quarters shall trigger an automatic supplemental appropriation from the reserve fund established under section 601(a)(2)(G) sufficient to close the gap within 24 months.

Rationale: The current mental health crisis cannot be solved by insurance coverage alone if there are no providers. This section creates an enforceable, measurable workforce mandate with real funding behind it.

(a) IN GENERAL.—The Secretary shall establish a Patient Safety Rapid Response Authority empowered to act on patient safety complaints, sentinel events, and quality-of-care failures within 30 days of credible report, modeled on the CMS Immediate Jeopardy determination process.

(b) DETERMINATION TIMELINE.—Within 30 days of receipt of a credible complaint, the Authority shall complete on-site investigation, make a written determination of whether a patient safety violation has occurred, and impose corrective action or sanctions if warranted. There shall be no extensions absent extraordinary circumstances documented in writing.

(c) SANCTIONS.—Available sanctions include monetary penalties up to $500,000 per violation, suspension of new admissions until correction, termination of the participation agreement under section 301, and referral for criminal prosecution under section 411 where warranted.

(d) PUBLIC DISCLOSURE.—All final determinations under this section shall be published on a publicly accessible database within 14 days of issuance, including the name of the provider, the nature of the violation, and the sanction imposed.

Rationale: Patient safety complaints currently disappear into bureaucratic processes lasting years. A 30-day determination timeline with real teeth ensures that providers face consequences while patients can still benefit from the protection.

(1) NATIONAL FEE SCHEDULE TIMELINE.—Notwithstanding section 612(b), the Secretary shall publish the initial national fee schedule for items and services not later than 6 months after the date of the enactment of this Act, with public comment period and final publication not later than 9 months after enactment.

(2) QUARTERLY GLOBAL BUDGET PAYMENTS BASED ON SCHEDULE.—Institutional providers paid under section 611 shall receive quarterly global budget payments calculated by reference to the national fee schedule established under section 612(b), adjusted for patient volume, severity, and case mix as determined by the regional director.

(3) COMPENSATION CEILINGS.—The following compensation ceilings shall apply to all persons paid in whole or in part with funds disbursed under this Act:

(A) CLINICAL PROVIDERS.—No individual clinical provider — including any physician, surgeon, neurosurgeon, orthopedic surgeon, nurse practitioner, physician assistant, or other licensed practitioner who delivers direct patient care — may receive total annual compensation in excess of $1,500,000 from all sources combined under this Act. Higher base compensation within this ceiling is expressly permitted for more highly skilled specialties such as neurosurgery, cardiothoracic surgery, and orthopedic surgery, reflecting the training, skill, and risk those specialties require. Extraordinary clinical performance shall be rewarded through bonuses earned under section 806, which are excluded from this ceiling. Compensation in excess of $1,500,000 (exclusive of section 806 bonuses) shall be returned to the Universal Medicare Trust Fund.

(B) ADMINISTRATORS AND NON-CLINICAL STAFF.—No administrator, manager, or other non-clinical employee of an institutional provider, regional office, or any program funded under this Act may receive total annual compensation in excess of $250,000. This ceiling is established to prevent the accumulation of large numbers of highly paid administrators at taxpayer expense — the pattern seen in many public school districts and public agencies, where thousands of administrators draw salaries between $200,000 and $500,000 while delivering no direct service. Public dollars are for care, not for administrative empire-building.

(C) HIGHEST EXECUTIVE ADMINISTRATOR.—A single highest-ranking executive administrator per institutional provider or regional office may receive total annual compensation not to exceed $450,000. No other administrator at such institution or office may exceed the $250,000 ceiling established in subparagraph (B). No institution or office may designate more than one position as eligible for the $450,000 ceiling.

(D) ENFORCEMENT.—Any compensation paid in excess of the ceilings established in this paragraph shall be recovered by the Secretary and returned to the Universal Medicare Trust Fund. Knowing or willful evasion of these ceilings — including through deferred compensation, consulting arrangements, related-party payments, or any other device — shall constitute a violation enforceable under section 411 and shall subject the responsible executives and board members to personal liability under subparagraph (D) of paragraph (4).

(4) ANTI-CORRUPTION SAFEGUARDS.—To prevent fraud, waste, and self-dealing in the administration of institutional payments, the Secretary shall implement the following enforceable safeguards:

(A) MONTHLY RECONCILIATION.—Regional directors shall conduct monthly reconciliation of every institutional provider's actual service delivery against budgeted payments, with discrepancies of more than 5 percent triggering automatic audit.

(B) MONTHLY SERVICE REPORTS.—Institutional providers shall submit monthly reports detailing services rendered, patient counts by category, staffing levels, and any deviations from budgeted operations. False reports shall constitute a violation of section 411.

(C) REAL-TIME AUDIT SYSTEM.—The Secretary shall maintain a real-time audit system with continuous monitoring of all institutional provider payments, automatic flagging of anomalous patterns, and immediate referral of suspected fraud to the Department of Justice.

(D) PERSONAL LIABILITY FOR FRAUD.—Executives, board members, and senior administrators of institutional providers shall be personally liable under 18 U.S.C. § 1347 (health care fraud) for knowing or reckless submission of false reports, false billing, or false certifications under this Act. Personal liability shall include disgorgement of compensation received during the period of violation, civil penalties, and where warranted, criminal prosecution.

Rationale: A program disbursing trillions of dollars annually cannot rely on after-the-fact discovery of fraud. Monthly reconciliation, real-time monitoring, and personal liability for executives — not just the corporate entity — ensure that the people making decisions about other people's health dollars face direct consequences for misconduct.

There is hereby imposed on every employer a graduated health contribution on wages paid to employees, scaled by employer size. No employer is categorically exempt; the only employers that do not contribute under this section are those with gross annual revenue below $500,000 that operate at a loss. The graduated payroll rate structure is as follows:

The Secretary of the Treasury shall adjust all thresholds annually for inflation beginning in Year 3. The corporate profit levy is set out separately in Section 705.

Estimated annual revenue — employer payroll contribution: ≈ $500 billion (good-faith estimate).

Every household with annual income below $50,000 is fully exempt from any contribution under this section. No exceptions, no paperwork, no means testing beyond income verification already conducted by the Internal Revenue Service. A family earning $49,999 pays nothing.

Every household with annual income between $50,000 and $100,000 shall contribute $100 per month to the Universal Medicare Trust Fund. The employer of each contributing employee in this income tier shall match this contribution dollar-for-dollar, contributing an additional $100 per month on behalf of that employee. Combined annual contribution per worker in this tier: $2,400 ($1,200 employee + $1,200 employer).

Rationale: The previous structure imposed a 4 percent income-based premium beginning at $29,000 in household income. A family earning $35,000 would have paid $1,400 per year — a genuine hardship. A flat $100 per month for households earning $50,000 to $100,000, matched by the employer, is predictable, plannable, and dramatically lower than what those families currently pay in insurance premiums. A family earning $65,000 currently pays an average of $6,296 per year in employee premium contributions plus $3,564 in out-of-pocket costs. Under this structure they pay $1,200. Their employer, who currently pays over $13,000 per year in premiums for that worker, pays $1,200. Both save money. Both get better coverage.

Estimated annual revenue (employee + employer combined, net of tax offsets): $79 billion.

Every employee earning in excess of $100,000 annually shall contribute $150 per month to the Universal Medicare Trust Fund, matched dollar-for-dollar by the employer, for a combined contribution of $300 per month. This contribution is in addition to the employer health contribution under Section 702.

A worker earning $120,000 annually contributes $1,800 per year. Their employer contributes a matching $1,800 per year. The worker currently pays an average of $7,884 per year in employer-sponsored premium contributions. Under this structure they pay $1,800 — a savings of $6,084 per year for the employee alone.

Estimated annual revenue (employee + employer combined, net of tax offsets): $135 billion.

A levy shall be imposed on the net profits of corporations as follows, applied on profits above each threshold only: 3 percent on annual net profit exceeding $500,000,000; 6 percent on annual net profit exceeding $1,000,000,000; 10 percent on annual net profit exceeding $10,000,000,000. Corporations with annual net profit below $500,000,000 are fully exempt from this levy. Small and mid-size businesses are completely unaffected.

This structure places the entire weight of this provision on the ultra-profitable: the largest technology corporations, Wall Street financial institutions, energy companies, and pharmaceutical manufacturers — precisely those entities that have extracted the most wealth from the broken system this Act replaces.

Note on private health insurers: UnitedHealth Group, CVS Health/Aetna, Cigna, Elevance Health, Humana, Centene, and all other private health insurers whose primary business is selling health insurance coverage that duplicates benefits provided under this Act are not projected as profit levy contributors because their core business ceases to exist under Section 107 of this Act. Their elimination from the healthcare market is the correct policy outcome. The approximately $350 billion they collectively extracted annually from American employers, workers, and families — in overhead, executive compensation, shareholder dividends, stock buybacks, and profit — is recaptured by the elimination of their market entirely, not by taxing their continued operation. No transition assistance under Section 601(b) shall be provided to executives, board members, or shareholders of these entities. Transition assistance shall be provided to their rank-and-file employees, who performed jobs that should never have been necessary.

Estimated annual profit levy revenue: $185–220 billion, drawn primarily from technology, financial services, energy, and pharmaceutical sectors.

A tax of 0.1 percent shall be imposed on the sale or exchange of stocks, bonds, derivatives, and other financial instruments. Individual retail investors with transaction volumes under $25,000 annually and qualified retirement accounts under section 401(k) and section 403(b) of the Internal Revenue Code are fully exempt from this tax. The Secretary shall promulgate regulations to implement this tax in a manner that does not impede ordinary retirement savings or middle-class wealth accumulation. Estimated annual revenue: ≈ $78 billion. The Congressional Budget Office and Joint Committee on Taxation score a 0.1 percent financial transactions tax at roughly $777 billion over ten years.

The corporate income tax rate is hereby restored to 28 percent for corporations with annual net income above $10,000,000. Corporations with net income below $10,000,000 retain the current statutory rate. This restoration reverses a portion of the 2017 corporate tax reduction with respect to large profitable corporations only. Estimated annual revenue: $100 billion.

(a) AUTOMATIC TAX REDUCTION.—When the Comptroller General of the United States verifies that the Medicare for All Program has achieved net savings of 5 percent, 10 percent, 15 percent, or 20 percent below the Congressional Budget Office baseline projection for total national health expenditures, the corresponding percentage of the additional revenues generated by sections 702 through 707 shall be automatically and proportionally returned to taxpayers through reductions in the rates imposed under those sections.

(b) IMPLEMENTATION.—The Secretary of the Treasury shall, within 90 days of each verification by the Comptroller General under subsection (a), implement the proportional rate reductions for the next succeeding tax year. Such reductions shall be permanent unless reversed by a subsequent verification showing savings have fallen below the relevant threshold.

(c) PURPOSE.—This section ensures that savings achieved by this Act flow back to the American people rather than being captured by the Federal Government as additional revenue. As the system grows more efficient, taxpayers pay less. The trigger is self-executing and does not require new authorizing legislation.

There is hereby appropriated $15,000,000,000 annually for a National Health Media Campaign administered by the Secretary in consultation with the Surgeon General. The campaign shall produce and distribute television, digital, print, and in-school content promoting healthy eating, regular physical activity, smoking cessation, and mental wellness. The campaign shall be aspirational rather than punitive in tone, modeled on the most effective anti-tobacco campaigns of the 1990s and 2000s. The $15 billion annual appropriation is calibrated to match approximately the $15 billion that fast-food and sugary-beverage industries spend annually on advertising to American consumers. Content shall be culturally responsive, available in major languages, and freely available for use by State and local health departments.

There is hereby established the National Wellness Contest System, to be administered by the Secretary, with annual appropriations of $3,000,000,000. The system shall include: (1) individual cash prizes of up to $25,000 for verified measurable improvements in health markers including weight loss, blood pressure reduction, cholesterol reduction, blood glucose normalization, and smoking cessation; (2) community grants of $10,000,000 to $50,000,000 awarded to municipalities, counties, tribal governments, or community organizations achieving the greatest aggregate population health improvements; (3) the National Innovation Prize of $1,000,000 awarded annually for the most effective new community-level health intervention; and (4) school competitions awarding equipment, facilities upgrades, and scholarship funds to schools demonstrating greatest improvement in student fitness, nutrition, and mental wellness metrics.

There is hereby established the Healthy Patient Physician Bonus Program with annual appropriations of $8,000,000,000. The program shall provide direct bonuses to participating physicians, nurse practitioners, and physician assistants based on measurable improvement in their patients' health outcomes:

(1) $25,000 per provider annually for achieving 10 percent improvement in panel-wide metrics for blood pressure control, diabetes management, weight management, or smoking cessation.

(2) $60,000 per provider annually for achieving 20 percent improvement.

(3) $100,000 per provider annually for achieving 30 percent improvement.

(4) $2,500 per documented and verified case of Type 2 diabetes reversal achieved through lifestyle intervention as primary treatment modality.

Eligibility for bonus payments shall require completion of 40 hours of continuing medical education in clinical nutrition, behavioral change counseling, and lifestyle medicine each calendar year. Bonus payments are exempt from the individual provider compensation cap established under Section 612 amendments.

There is hereby appropriated $12,000,000,000 annually for community wellness infrastructure. Funds shall be distributed by regional directors to fund: free community Tai Chi, qigong, yoga, and stretching programs in every county; pickleball, walking, and recreational programs in every community; community gardens and farmers markets, with priority placement in food deserts as defined by the Department of Agriculture; cycling and pedestrian infrastructure; community swimming pools, gymnasiums, and fitness facilities open to all residents at no cost; and culturally specific traditional movement and wellness practices in coordination with Indian Health Service and tribal governments. Not less than 40 percent of funds shall be directed to communities with social vulnerability index scores in the highest quartile.

There is hereby appropriated $5,000,000,000 annually for food environment reform programs administered by the Secretary in consultation with the Secretary of Agriculture:

(1) BAN ON SUGAR ADVERTISING TO CHILDREN.—No advertisement for any food or beverage containing more than 5 grams of added sugar per serving may be directed at children under 12 years of age in any medium. The Federal Trade Commission shall promulgate implementing regulations not later than 6 months after enactment.

(2) GROCERY SUBSIDIES IN FOOD DESERTS.—Grants and subsidies for the establishment and operation of full-service grocery stores in census tracts designated as food deserts.

(3) SNAP FRESH-PRODUCE MULTIPLIER.—The face value of Supplemental Nutrition Assistance Program (SNAP) benefits shall be multiplied by 2:1 when used to purchase fresh fruits, fresh vegetables, dried beans, and unprocessed whole grains.

(4) WHOLE-FOOD SCHOOL LUNCHES.—Federal reimbursement rates for school lunch programs shall be increased to fully fund whole-food, scratch-cooked meals using fresh ingredients in every public school. Highly processed and ultra-processed foods, as defined by the Secretary, shall be phased out of federally reimbursed school meals over a 3-year period.

The Secretary shall publish annual national health outcome reports tracking obesity prevalence, Type 2 diabetes prevalence and incidence, cardiovascular event rates, cancer incidence, infant mortality, life expectancy, and per-capita health expenditures. Each program funded under sections 804 through 808 shall be evaluated annually against pre-established performance metrics. Programs failing to demonstrate measurable progress over two consecutive years shall be modified, redirected, or terminated. Programs demonstrating exceptional results shall be expanded with supplemental appropriations from the reserve fund.

Based on peer-reviewed public health literature, international comparison data, and modeling derived from the Finland North Karelia Project (which achieved an 85 percent reduction in cardiovascular mortality over 35 years through community-based lifestyle intervention without new drugs or new technology), the projected return on the $45 billion annual investment in sections 804 through 808 is as follows: Year 1, $85–120 billion in health expenditure savings; Year 5, $550–750 billion; Year 10, $900 billion to $1.2 trillion; representing an approximate 27:1 return on investment by Year 10. These projections shall be reviewed and updated annually by the Comptroller General.

(a) MINIMUM ACCESS STANDARD.—The Secretary shall ensure that no resident of the United States is required to travel more than 35 miles by ground transportation to reach an inpatient hospital providing emergency services, obstetric services, and basic acute inpatient care.

(b) IDENTIFICATION OF AT-RISK FACILITIES.—Within 6 months of enactment, the Secretary shall identify and publish a list of all rural hospitals at risk of closure, including not less than the 600 hospitals identified by the Center for Healthcare Quality and Payment Reform as facing imminent financial distress.

(c) PRIORITY GLOBAL BUDGET ADJUSTMENTS.—Hospitals identified under subsection (b) shall receive priority global budget adjustments under section 611 sufficient to ensure their continued operation, including supplemental payments to cover legacy debt, deferred capital expenditures, and minimum staffing requirements. Such adjustments are not subject to the limitation under section 611(b)(3).

(d) NEW FACILITY CONSTRUCTION.—Where closure of an existing facility cannot be prevented, or where the 35-mile standard cannot be met by existing facilities, the Secretary shall use the special projects budget under section 601(a)(2)(C) to fund construction of new rural hospitals, critical access hospitals, freestanding emergency departments, or other facilities sufficient to meet the standard within 36 months.

(e) WORKFORCE MANDATE.—The Secretary shall ensure adequate staffing of rural facilities through expansion of the National Health Service Corps, loan repayment for clinicians serving in rural areas for not less than 4 years, and supplemental compensation for rural service. The Secretary shall coordinate with section 503 mental health workforce mandates to ensure mental health and substance use services are available at every rural facility.

Rationale: Approximately 600 rural hospitals are currently at risk of closure. Closure of a rural hospital is a death sentence for portions of the population it serves. A 35-mile minimum access standard, combined with mandatory priority funding and workforce build-out, prevents this entirely foreseeable catastrophe.

(a) IN GENERAL.—If any provision of this Act, any amendment made by this Act, or the application of any such provision or amendment to any person or circumstance, is held to be unconstitutional or otherwise invalid, the remainder of this Act, the remainder of any such amendment, and the application of such provision or amendment to other persons or circumstances shall not be affected.

(b) INTENT OF CONGRESS.—Congress declares that each provision of this Act is intended to operate independently. Congress would have enacted each provision separately even in the absence of any other provision found invalid. No court may invalidate the entire Act, any title of the Act, any subtitle of the Act, or any section of the Act on the grounds that any subordinate provision is held invalid.

Rationale: This provision prevents litigation from being used to dismantle the entire program through challenge of any single subordinate provision. Each provision must stand or fall on its own merits.

(a) PROHIBITION ON NATIONWIDE INJUNCTIONS PENDING APPEAL.—Notwithstanding any other provision of Federal law, no court of the United States shall issue an injunction, temporary restraining order, or other order that has the effect of freezing operation of this Act in its entirety, freezing operation of any title of this Act in its entirety, or preventing the Secretary from continuing to enroll, provide benefits to, or pay providers on behalf of eligible individuals, while a challenge to any particular provision of this Act is pending.

(b) NARROW TAILORING REQUIRED.—Any injunctive relief granted with respect to any provision of this Act shall be narrowly tailored to address only the specific provision held invalid and only the specific parties before the court. No court may issue any injunction broader than the minimum necessary to remedy the specific harm proven by the party seeking such relief.

(c) APPELLATE REVIEW.—Any injunction issued under this section shall be subject to expedited appellate review, with the United States Court of Appeals for the circuit in which the district court sits required to render a decision within 45 days of filing of notice of appeal.

Rationale: These limitations are essential to ensure that opponents cannot use a single sympathetic court in a single district to stop the entire program from delivering benefits to 330 million Americans during years of appeals.