Medicare for America Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 2452 To amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans. IN THE HOUSE OF REPRESENTATIVES MAY 1, 2019 Ms. DELAURO (for herself, Ms. SCHAKOWSKY, Mr. KENNEDY, Mr. CLAY, Ms. NORTON, Mr. GRIJALVA, Mr. CARBAJAL, Mrs. TRAHAN, Mr. RYAN, Ms. JACKSON LEE, Mr. THOMPSON of Mississippi, Ms. ROYBAL-ALLARD, Ms. MCCOLLUM, Ms. MOORE, Mr. RUSH, and Mr. HIGGINS of New York) in- troduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, Education and Labor, the Judiciary, Natural Resources, and House Ad- ministration, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the juris- diction of the committee concerned A BILL To amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans. 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 America Act of 2019’’. 5 VerDate Sep 11 2014 20:58 May 08, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2452.IH H2452 pamtmann on DSKBFK8HB2PROD with BILLS 2 •HR 2452 IH (b) TABLE OF CONTENTS.—The table of contents of 1 this Act is as follows: 2 Sec. 1. Short title; table of contents. TITLE I—TRANSITIONING TO AND ESTABLISHING MEDICARE FOR AMERICA Subtitle A—Transitional Public Health Option Sec. 101. Establishment. Sec. 102. Eligibility. Sec. 103. Benefits. Sec. 104. Premiums. Sec. 105. Providers and reimbursement rates. Sec. 106. Account; funding. Subtitle B—Medicare for America Sec. 111. Establishment and administration of Medicare for America. Sec. 112. Modifications to and coordination with existing Federal health pro- grams. Subtitle C—Targeted Reforms Sec. 121. No surprise billing. Sec. 122. Limitation on removal of Medicare Advantage providers by MA orga- nizations. Sec. 123. Network adequacy. Sec. 124. Eliminating the 24-month waiting period for Medicare coverage for individuals with disabilities. Sec. 125. Eliminating the waiting period for individuals on State Medicaid waiting lists. Sec. 126. Employer health plan options. Sec. 127. Prohibition on step therapy and prior authorization under group health plans. Sec. 128. Medicare outpatient observation services. Sec. 129. Abortion coverage. Sec. 130. Applicability of mental health parity. Sec. 131. Student loan forgiveness for health care providers participating in Medicare for America. Sec. 132. Clarification of the definition of pediatric medical necessity in quali- fying group coverage. Sec. 133. Safe staffing requirements. Sec. 134. Enhancements for reduced cost-sharing. Sec. 135. Repeal of bonus payments for Medicare Advantage plans. TITLE II—TAX PROVISIONS Sec. 201. Sunset of Public Law 115–97. Sec. 202. Surtax. Sec. 203. Basis of property acquired from a decedent. Sec. 204. Medicare payroll tax. Sec. 205. Net investment income tax. Sec. 206. Termination of deduction for contributions to health savings ac- counts. VerDate Sep 11 2014 20:58 May 08, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H2452.IH H2452 pamtmann on DSKBFK8HB2PROD with BILLS 3 •HR 2452 IH Sec. 207. Increase in excise tax on small cigars and cigarettes and other to- bacco products. Sec. 208. Excise tax on alcohol. Sec. 209. Tax on sugared drinks. Sec. 210. Repeal of excise tax on high-cost employer-sponsored health coverage. TITLE III—DRUG-RELATED PROVISIONS Sec. 301. Establishment of the Prescription Drug and Medical Device Review Board. Sec. 302. Membership; staff. Sec. 303. Prohibition against excessive price. Sec. 304. Enforcement provisions. Sec. 305. Authority. Sec. 306. Regulations. Sec. 307. Report to Federal agencies. Sec. 308. Definitions. Sec. 309. Moratorium on direct-to-consumer drug advertising. Sec. 310. Reporting on justification for drug price increases. TITLE IV—OUTCOMES AND REPORTING Sec. 401. Sense of Congress. Sec. 402. Evaluation of bill’s outcome. TITLE I—TRANSITIONING TO 1 AND ESTABLISHING MEDI- 2 CARE FOR AMERICA 3 Subtitle A—Transitional Public 4 Health Option 5 SEC. 101. ESTABLISHMENT. 6 The Secretary of Health and Human Services (in this 7 subtitle referred to as the ‘‘Secretary’’) shall establish a 8 public health plan option that is offered in the individual 9 market through the Federal and State Exchanges under 10 title I of the Patient Protection and Affordable Care Act 11 to eligible individuals for plan years 2021 and 2022 in 12 accordance with this subtitle. 13 VerDate Sep 11 2014 20:58 May 08, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2452.IH H2452 pamtmann on DSKBFK8HB2PROD with BILLS 4 •HR 2452 IH SEC. 102. ELIGIBILITY. 1 Subject to subsection (b), an individual is eligible to 2 enroll in such public health plan option if the individual 3 is otherwise eligible to purchase individual health insur- 4 ance coverage through an Exchange and the individual re- 5 sides in a rating area in which the Secretary makes the 6 public health plan option available. 7 SEC. 103. BENEFITS. 8 (a) IN GENERAL.—The public health plan option 9 shall be a qualified health plan within the meaning of sec- 10 tion 1301(a) of the Patient Protection and Affordable 11 Care Act (42 U.S.C. 18021(a)) that— 12 (1) meets all requirements applicable to quali- 13 fied health plans under subtitle D of title I of the 14 Patient Protection and Affordable Care Act (other 15 than the requirement under section 16 1301(a)(1)(C)(ii) of such Act (42 U.S.C. 17 18021(a)(1)(C)(ii))) and title XXVII of the Public 18 Health Service Act; 19 (2) provides coverage of the essential health 20 benefits described in section 1302(b) of the Patient 21 Protection and Affordable Care Act (42 U.S.C. 22 18022(b)); 23 (3) provides silver and gold-level coverage de- 24 scribed in section 1302(d)(1)(C) of the Patient Pro- 25 VerDate Sep 11 2014 20:58 May 08, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2452.IH H2452 pamtmann on DSKBFK8HB2PROD with BILLS 5 •HR 2452 IH tection and Affordable Care Act (42 U.S.C. 1 18022(d)(1)(C)); and 2 (4) provides coverage of comprehensive repro- 3 ductive health services, including abortion. 4 (b) PREEMPTION.—Notwithstanding section 5 1303(a)(1) of the Patient Protection and Affordable Care 6 Act (42 U.S.C. 18023(a)(1))— 7 (1) a State may not prohibit the public health 8 plan option from offering the coverage described in 9 subsection (a)(4); and 10 (2) no State law that would prohibit such a 11 plan from offering such coverage shall apply to such 12 plan. 13 SEC. 104. PREMIUMS. 14 (a) IN GENERAL.—The Secretary shall establish pre- 15 mium rates for the public health plan option that— 16 (1) are adjusted based on the applicable rating 17 area; 18 (2) are at a level sufficient to fully finance— 19 (A) the costs of health benefits provided by 20 such plans; and 21 (B) administrative costs related to oper- 22 ating the plans; 23 VerDate Sep 11 2014 20:58 May 08, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2452.IH H2452 pamtmann on DSKBFK8HB2PROD with BILLS 6 •HR 2452 IH (3) comply with the requirements under section 1 2701 of the Public Health Service Act (42 U.S.C. 2 300gg); and 3 (4) ensure that no individual or household will 4 pay more than 8 percent of adjusted gross monthly 5 income toward the monthly premium. 6 (b) FEDERAL SUBSIDIES.—Federal subsidies shall be 7 provided to ensure that the premium shall be— 8 (1) zero in the case of an individual whose an- 9 nual household income is below 200 percent of the 10 poverty line; 11 (2) determined by a linear sliding scale, in the 12 case of an individual whose household income is at 13 least 200 percent of the poverty line, but not more 14 than 600 percent of the poverty line; and 15 (3) no individual or household above 600 per- 16 cent of poverty level will pay more than 8 percent 17 of adjusted gross monthly income toward such 18 monthly premium. 19 SEC. 105. PROVIDERS AND REIMBURSEMENT RATES. 20 (a) IN GENERAL.—The Secretary shall establish a 21 rate schedule for reimbursing types of health care pro- 22 viders furnishing items and services under the public 23 health insurance plan option at rates based on rates ap- 24 plied for such items and services under title XVIII of the 25 VerDate Sep 11 2014 20:58 May 08, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2452.IH H2452 pamtmann on DSKBFK8HB2PROD with BILLS 7 •HR 2452 IH Social Security Act, as of the date of the enactment of 1 this Act, that are necessary to maintain network ade- 2 quacy. The Secretary shall establish a rate schedule for 3 items and services not currently covered under title XVIII 4 of the Social Security Act, such as dental, vision, and 5 hearing benefits, well child visits, and reproductive health 6 services, at a level to ensure adequate access to providers. 7 (b) PARTICIPATING PROVIDERS.— 8 (1) IN GENERAL.—A health care provider that 9 is a participating provider of services or supplier 10 under the Medicare program under title XVIII of 11 the Social Security Act or under the Medicaid pro- 12 gram under title XIX of such Act on the date of en- 13 actment of this title shall be a participating provider 14 for the public health insurance plan option. 15 (2) ADDITIONAL PROVIDERS.—The Secretary 16 shall establish a process to allow health care pro- 17 viders not described in paragraph (1) to become par- 18 ticipating providers for the public health insurance 19 plan option. 20 (3) CLARIFICATION.—Notwithstanding any 21 other provision of law, health care providers may not 22 be prohibited from participating in the public health 23 insurance option for reasons other than their ability 24 to provide covered services. Health care providers 25 VerDate Sep 11 2014 20:58 May 08, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2452.IH H2452 pamtmann on DSKBFK8HB2PROD with BILLS 8 •HR 2452 IH and institutions are prohibited from denying covered 1 individuals access to any covered benefits and serv- 2 ices because of their religious objections. 3 (c) PRESCRIPTION DRUGS.—The Secretary shall 4 apply the provisions of section 1860D–11(i) of the Social 5 Security Act (42 U.S.C. 1395w–111(i)) to prescription 6 drugs under the public health plan option in the same 7 manner as such provisions apply with respect to applicable 8 covered part D drugs under such section. 9 SEC. 106. ACCOUNT; FUNDING. 10 (a) ESTABLISHMENT.—There is established in the 11 Treasury of the United States an account for the receipts 12 and disbursements attributable to the operation of the 13 public health plan option. 14 (b) APPROPRIATION.—There is appropriated to the 15 account established under subsection (a), out of any funds 16 in the Treasury not otherwise obligated, such sums as may 17 be necessary to be used by the Secretary for purposes of 18 carrying out this part. 19 (c) PROHIBITION OF STATE IMPOSITION OF 20 TAXES.—Section 1854(g) of the Social Security Act (42 21 U.S.C. 1395w–24(g)) shall apply to receipts and disburse- 22 ments described in subsection (a) in the same manner as 23 such section applies to payments or premiums described 24 in such section. 25 VerDate Sep 11 2014 20:58 May 08, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2452.IH H2452 pamtmann on DSKBFK8HB2PROD with BILLS 9 •HR 2452 IH (d) CLARIFICATION.—Any provision of law restricting 1 the use of Federal funds with respect to any reproductive 2 health service shall not apply to funds appropriated under 3 subsection (b) or with respect to the account under sub- 4 section (a). 5 Subtitle B—Medicare for America 6 SEC. 111. ESTABLISHMENT AND ADMINISTRATION OF MEDI- 7 CARE FOR AMERICA. 8 The Social Security Act is amended by adding at the 9 end the following new title: 10 ‘‘TITLE XXII—MEDICARE FOR 11 AMERICA 12 ‘‘PART A—COMPREHENSIVE HEALTH COVERAGE 13 ‘‘SEC. 2201. ESTABLISHMENT. 14 ‘‘The Secretary shall establish a public health insur- 15 ance program, to be known as ‘Medicare for America’, 16 which shall for calendar year 2023 and each subsequent 17 calendar year provide comprehensive health benefits in ac- 18 cordance with this part to individuals enrolled for coverage 19 under this title. 20 ‘‘SEC. 2202. ELIGIBILITY; AUTOMATIC ENROLLMENT. 21 ‘‘(a) ELIGIBLE INDIVIDUALS.—For purposes of this 22 title, every individual who is— 23 ‘‘(1) a resident of the United States or a terri- 24 tory of the United States; 25 VerDate Sep 11 2014 20:58 May 08, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2452.IH H2452 pamtmann on DSKBFK8HB2PROD with BILLS 10 •HR 2452 IH ‘‘(2) an individual who is lawfully present, as 1 defined in section 152.2 of title 45 of the Code of 2 Federal Regulations; or 3 ‘‘(3) an individual who would be eligible for cov- 4 erage under a State Medicaid plan pursuant to sec- 5 tion 1903(v) (as such section was in effect as of the 6 date of the enactment of this title), 7 is entitled to benefits for health care services under this 8 title. The Secretary shall promulgate a rule that provides 9 criteria for applying this subsection, including determining 10 residency for eligibility purposes under this title. Nothing 11 in this title shall preclude a State from using State funds 12 to provide for an individual’s health coverage who is not 13 eligible under this subsection. 14 ‘‘(b) ENROLLMENTS.—Subject to subsection (c): 15 ‘‘(1) IN GENERAL.—Beginning in 2023, the 16 Secretary shall provide a mechanism for the enroll- 17 ment of individuals entitled to benefits under this 18 title and, in conjunction with such enrollment, the 19 issuance of a Medicare for America card which may 20 be used for purposes of identification and processing 21 of claims for benefits under this title. The card shall 22 not use the individual’s social security number as an 23 identifier. As a condition of participation in the pro- 24 gram, participating providers shall facilitate enroll- 25 VerDate Sep 11 2014 20:58 May 08, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2452.IH H2452 pamtmann on DSKBFK8HB2PROD with BILLS 11 •HR 2452 IH ment as specified by the Secretary. The State enti- 1 ties responsible for enrolling individuals in the Med- 2 icaid program under title XIX and the Children’s 3 Health Insurance Program under title XXI shall 4 serve as the enrolling entity for Medicare for Amer- 5 ica within each State. 6 ‘‘(2) AUTOMATIC ENROLL [Text truncated for display. Full text available on Congress.gov.]