Medicare for All Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1129 To establish a Medicare-for-all national health insurance program. IN THE SENATE OF THE UNITED STATES APRIL 10, 2019 Mr. SANDERS (for himself, Ms. BALDWIN, Mr. BLUMENTHAL, Mr. BOOKER, Mrs. GILLIBRAND, Ms. HARRIS, Mr. LEAHY, Mr. MARKEY, Mr. MERKLEY, Mr. SCHATZ, Mr. UDALL, Ms. WARREN, Mr. WHITEHOUSE, Ms. HIRONO, and Mr. HEINRICH) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To establish a Medicare-for-all national health insurance program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Medicare for All Act of 2019’’. 5 (b) TABLE OF CONTENTS.—The table of contents for 6 this Act is as follows: 7 Sec. 1. Short title; table of contents. TITLE I—ESTABLISHMENT OF THE UNIVERSAL MEDICARE PROGRAM; UNIVERSAL ENTITLEMENT; ENROLLMENT VerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S1129.IS S1129 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 1129 IS Sec. 101. Establishment of the Universal Medicare Program. Sec. 102. Universal entitlement. Sec. 103. Freedom of choice. Sec. 104. Non-discrimination. Sec. 105. Enrollment. Sec. 106. Effective date of benefits. Sec. 107. Prohibition against duplicating coverage. TITLE II—COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE BENEFITS AND BENEFITS FOR LONG-TERM CARE Sec. 201. Comprehensive benefits. Sec. 202. No cost-sharing. Sec. 203. Exclusions and limitations. Sec. 204. Coverage of institutional long-term care services under Medicaid. Sec. 205. Prohibiting recovery of correctly paid Medicaid benefits. Sec. 206. State standards. TITLE III—PROVIDER PARTICIPATION Sec. 301. Provider participation and standards. Sec. 302. Qualifications for providers. Sec. 303. Use of private contracts. TITLE IV—ADMINISTRATION Subtitle A—General Administration Provisions Sec. 401. Administration. Sec. 402. Consultation. Sec. 403. Regional administration. Sec. 404. Beneficiary ombudsman. Sec. 405. Complementary conduct of related health programs. Subtitle B—Control Over Fraud and Abuse Sec. 411. Application of Federal sanctions to all fraud and abuse under Uni- versal Medicare Program. TITLE V—QUALITY ASSESSMENT Sec. 501. Quality standards. Sec. 502. Addressing health care disparities. TITLE VI—HEALTH BUDGET; PAYMENTS; COST CONTAINMENT MEASURES Subtitle A—Budgeting Sec. 601. National health budget. Subtitle B—Payments to Providers Sec. 611. Payments to institutional and individual providers. Sec. 612. Ensuring accurate valuation of services under the Medicare physician fee schedule. Sec. 613. Office of primary health care. Sec. 614. Payments for prescription drugs and approved devices and equip- ment. VerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S1129.IS S1129 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 1129 IS TITLE VII—UNIVERSAL MEDICARE TRUST FUND Sec. 701. Universal Medicare Trust Fund. TITLE VIII—CONFORMING AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 Sec. 801. Prohibition of employee benefits duplicative of benefits under the Universal Medicare Program; coordination in case of workers’ compensation. Sec. 802. Repeal of continuation coverage requirements under ERISA and cer- tain other requirements relating to group health plans. Sec. 803. Effective date of title. TITLE IX—ADDITIONAL CONFORMING AMENDMENTS Sec. 901. Relationship to existing Federal health programs. Sec. 902. Sunset of provisions related to the State Exchanges. TITLE X—TRANSITION Subtitle A—Transitional Medicare Buy-In Option and Transitional Public Option Sec. 1001. Lowering the Medicare age. Sec. 1002. Establishment of the Medicare transition plan. Subtitle B—Transitional Medicare Reforms Sec. 1011. Medicare protection against high out-of-pocket expenditures for fee- for-service benefits and elimination of parts A and B deduct- ibles. Sec. 1012. Reduction in Medicare part D annual out-of-pocket threshold and elimination of cost-sharing above that threshold. Sec. 1013. Coverage of dental and vision services and hearing aids and exami- nations under Medicare part B. Sec. 1014. Eliminating the 24-month waiting period for Medicare coverage for individuals with disabilities. Sec. 1015. Guaranteed issue of Medigap policies. Subtitle C—Private Health Insurance Availability During Transitional Period Sec. 1021. Continuity of care. TITLE XI—MISCELLANEOUS Sec. 1101. Updating resource limits for Supplemental Security Income eligi- bility (SSI). Sec. 1102. Definitions. VerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\S1129.IS S1129 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 1129 IS TITLE I—ESTABLISHMENT OF 1 THE UNIVERSAL MEDICARE 2 PROGRAM; UNIVERSAL ENTI- 3 TLEMENT; ENROLLMENT 4 SEC. 101. ESTABLISHMENT OF THE UNIVERSAL MEDICARE 5 PROGRAM. 6 There is hereby established a national health insur- 7 ance program to provide comprehensive protection against 8 the costs of health care and health-related services, in ac- 9 cordance with the standards specified in, or established 10 under, this Act. 11 SEC. 102. UNIVERSAL ENTITLEMENT. 12 (a) IN GENERAL.—Every individual who is a resident 13 of the United States is entitled to benefits for health care 14 services under this Act. The Secretary shall promulgate 15 a rule that provides criteria for determining residency for 16 eligibility purposes under this Act. 17 (b) TREATMENT OF OTHER INDIVIDUALS.—The Sec- 18 retary— 19 (1) may make eligible for benefits for health 20 care services under this Act other individuals not de- 21 scribed in subsection (a) and regulate their eligibility 22 to ensure that every person in the United States has 23 access to health care; and 24 VerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 1129 IS (2) shall promulgate a rule, consistent with 1 Federal immigration laws, to prevent an individual 2 from traveling to the United States for the sole pur- 3 pose of obtaining health care services provided under 4 this Act. 5 SEC. 103. FREEDOM OF CHOICE. 6 Any individual entitled to benefits under this Act may 7 obtain health services from any institution, agency, or in- 8 dividual qualified to participate under this Act. 9 SEC. 104. NON-DISCRIMINATION. 10 (a) IN GENERAL.—No person shall, on the basis of 11 race, color, national origin, age, disability, or sex, includ- 12 ing sex stereotyping, gender identity, sexual orientation, 13 and pregnancy and related medical conditions (including 14 termination of pregnancy), be excluded from participation 15 in, be denied the benefits of, or be subjected to discrimina- 16 tion by any participating provider as defined in section 17 301, or any entity conducting, administering, or funding 18 a health program or activity, including contracts of insur- 19 ance, pursuant to this Act. 20 (b) CLAIMS OF DISCRIMINATION.— 21 (1) IN GENERAL.—The Secretary shall establish 22 a procedure for adjudication of administrative com- 23 plaints alleging a violation of subsection (a). 24 VerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 1129 IS (2) JURISDICTION.—Any person aggrieved by a 1 violation of subsection (a) by a covered entity may 2 file suit in any district court of the United States 3 having jurisdiction of the parties. 4 (3) DAMAGES.—If the court finds a violation of 5 subsection (a), the court may grant compensatory 6 and punitive damages, declaratory relief, injunctive 7 relief, attorneys’ fees and costs, or other relief as ap- 8 propriate. 9 SEC. 105. ENROLLMENT. 10 (a) IN GENERAL.—The Secretary shall provide a 11 mechanism for the enrollment of individuals eligible for 12 benefits under this Act. The mechanism shall— 13 (1) include a process for the automatic enroll- 14 ment of individuals at the time of birth in the 15 United States or upon the establishment of resi- 16 dency in the United States; 17 (2) provide for the enrollment, as of the date 18 described in section 106, of all individuals who are 19 eligible to be enrolled as of such date; and 20 (3) include a process for the enrollment of indi- 21 viduals made eligible for health care services under 22 section 102(b). 23 (b) ISSUANCE OF UNIVERSAL MEDICARE CARDS.— 24 In conjunction with an individual’s enrollment for benefits 25 VerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129 pamtmann on DSKBFK8HB2PROD with BILLS 7 •S 1129 IS under this Act, the Secretary shall provide for the issuance 1 of a Universal Medicare card that shall be used for pur- 2 poses of identification and processing of claims for bene- 3 fits under this program. The card shall not include an in- 4 dividual’s Social Security number. 5 SEC. 106. EFFECTIVE DATE OF BENEFITS. 6 (a) IN GENERAL.—Except as provided in subsection 7 (b), benefits shall first be available under this Act for 8 items and services furnished on January 1 of the fourth 9 calendar year that begins after the date of enactment of 10 this Act. 11 (b) COVERAGE FOR CHILDREN.— 12 (1) IN GENERAL.—For any eligible individual 13 who has not yet attained the age of 19, benefits 14 shall first be available under this Act for items and 15 services furnished on January 1 of the first calendar 16 year that begins after the date of enactment of this 17 Act. 18 (2) OPTION TO CONTINUE IN OTHER COVERAGE 19 DURING TRANSITION PERIOD.—Any person who is 20 eligible to receive benefits as described in paragraph 21 (1) may opt to maintain any coverage described in 22 section 901, private health insurance coverage, or 23 coverage offered pursuant to subtitle A of title X 24 VerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129 pamtmann on DSKBFK8HB2PROD with BILLS 8 •S 1129 IS (including the amendments made by such subtitle) 1 until the effective date described in subsection (a). 2 SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE. 3 (a) IN GENERAL.—Beginning on the effective date 4 described in section 106(a), it shall be unlawful for— 5 (1) a private health insurer to sell health insur- 6 ance coverage that duplicates the benefits provided 7 under this Act; or 8 (2) an employer to provide benefits for an em- 9 ployee, former employee, or the dependents of an 10 employee or former employee that duplicate the ben- 11 efits provided under this Act. 12 (b) CONSTRUCTION.—Nothing in this Act shall be 13 construed as prohibiting the sale of health insurance cov- 14 erage for any additional benefits not covered by this Act, 15 including additional benefits that an employer may provide 16 to employees or their dependents, or to former employees 17 or their dependents. 18 TITLE II—COMPREHENSIVE BEN- 19 EFITS, INCLUDING PREVEN- 20 TIVE BENEFITS AND BENE- 21 FITS FOR LONG-TERM CARE 22 SEC. 201. COMPREHENSIVE BENEFITS. 23 (a) IN GENERAL.—Subject to the other provisions of 24 this title and titles IV through IX, individuals enrolled for 25 VerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129 pamtmann on DSKBFK8HB2PROD with BILLS 9 •S 1129 IS benefits under this Act are entitled to have payment made 1 by the Secretary to an eligible provider for the following 2 items and services if medically necessary or appropriate 3 for the maintenance of health or for the diagnosis, treat- 4 ment, or rehabilitation of a health condition: 5 (1) Hospital services, including inpatient and 6 outpatient hospital care, including 24-hour-a-day 7 emergency services and inpatient prescription drugs. 8 (2) Ambulatory patient services. 9 (3) Primary and preventive services, including 10 chronic disease management. 11 (4) Prescription drugs, medical devices, biologi- 12 cal products, including outpatient prescription drugs, 13 medical devices, and biological products. 14 (5) Mental health and substance abuse treat- 15 ment services, including inpatient care. 16 (6) Laboratory and diagnostic services. 17 (7) Comprehensive reproductive, maternity, and 18 newborn care. 19 (8) Pediatrics, including early and periodic 20 screening, diagnostic, and treatment services (as de- 21 fined in section 1905(r) of the Social Security Act 22 (42 U.S.C. 1396d(r))). 23 (9) Oral health, audiology, and vision services. 24 VerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129 pamtmann on DSKBFK8HB2PROD with BILLS 10 •S 1129 IS (10) Short-term rehabilitative and habilitative 1 services and devices. 2 (11) Emergency services and transportation. 3 (12) Necessary transportation to receive health 4 care services for individuals with disabilities and low- 5 income individuals. 6 (13) Home and community-based long-term 7 services and supports (to be provided in accordance 8 with the requirements for home and community- 9 based settings under sections 441.530 and 441.710 10 of title 42, Code of Federal Regulations), includ- 11 ing— 12 (A) services described in paragraphs (7), 13 (8), (13), (19), and (24) of section 1905(a) of 14 the Social Security Act (42 U.S.C. 1396d(a)); 15 (B) home and community-based services 16 described in subsection (c)(4)(B) of section 17 1915 of the Social Security Act (including ha- 18 bilitation services defined in subsection (c)(5) of 19 such section); 20 (C) self-directed home and community- 21 based services described in subsection (i) of sec- 22 tion 1915 of the Social Security Act; 23 VerDate Sep 11 2014 01:32 Apr 23, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1129.IS S1129 pamtmann on DSKBFK8HB2PROD with BILLS 11 •S 1129 IS (D) self-directed personal assistance serv- 1 ices (as defined in subsection (j)(4)(A) of sec- 2 tion 1915 of the Social Security Act); and 3 (E) home and community-based attendant 4 services and supports described in subsection 5 (k) of section 1915 of the Social Security Act. 6 (b) REVISION AND ADJUSTMENT.—The Secretary 7 shall, on a regular basis, evaluate whether the benefits 8 package should be improved or adjusted to promote the 9 health of beneficiaries, account for changes in medical 10 practice or new information from medical research, or re- 11 spond to other relevant developments in health science, 12 and shall make recommendations to Congress regarding 13 any such improvements or adjustments. 14 (c) COMPLEMENTARY AND INTEGRATIVE MEDI- 15 CINE.— [Text truncated for display. 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