Medicare for All Act

II 118TH CONGRESS 1ST SESSION S. 1655 To establish a Medicare-for-all national health insurance program. IN THE SENATE OF THE UNITED STATES MAY 17, 2023 Mr. SANDERS (for himself, Ms. BALDWIN, Mr. BLUMENTHAL, Mr. BOOKER, Mrs. GILLIBRAND, Mr. HEINRICH, Ms. HIRONO, Mr. LUJA´N, Mr. MAR- KEY, Mr. MERKLEY, Mr. PADILLA, Mr. SCHATZ, Ms. WARREN, Mr. WELCH, and Mr. WHITEHOUSE) 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’’. 5 (b) TABLE OF CONTENTS.—The table of contents for 6 this Act is as follows: 7 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1655.IS S1655 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •S 1655 IS Sec. 1. Short title; table of contents. TITLE I—ESTABLISHMENT OF THE MEDICARE FOR ALL PRO- GRAM; UNIVERSAL ENTITLEMENT TO BENEFITS; ENROLLMENT Sec. 101. Establishment of the Medicare for All Program. Sec. 102. Universal entitlement to benefits. Sec. 103. Freedom of choice. Sec. 104. Non-discrimination. Sec. 105. Enrollment. Sec. 106. Effective date of benefits. Sec. 107. Prohibition against duplicating coverage. TITLE II—COMPREHENSIVE BENEFITS, INCLUDING BENEFITS FOR LONG-TERM CARE Sec. 201. Comprehensive benefits. Sec. 202. No patient cost-sharing. Sec. 203. Exclusions and limitations. Sec. 204. Continued coverage of institutional long-term care and other services under Medicaid. Sec. 205. Prohibiting recovery of correctly paid Medicaid benefits. Sec. 206. Additional State standards. TITLE III—PROVIDER PARTICIPATION Sec. 301. Provider participation and standards; whistleblower protections. Sec. 302. Qualifications for providers. Sec. 303. Use of private contracts. TITLE IV—ADMINISTRATION Subtitle A—General Administration Provisions Sec. 401. Administration. Sec. 402. Consultation. Sec. 403. Regional administration. Sec. 404. Beneficiary Ombudsman. Sec. 405. Conduct of related health programs. Subtitle B—Control Over Fraud and Abuse Sec. 411. Application of Federal sanctions to all fraud and abuse under Medi- care for All Program. TITLE V—QUALITY OF CARE Sec. 501. Quality standards. Sec. 502. Addressing health care disparities. TITLE VI—NATIONAL HEALTH BUDGET; PROVIDER PAYMENTS; COST CONTAINMENT MEASURES Subtitle A—Budgeting Sec. 601. National health budget. Sec. 602. Temporary worker assistance. Subtitle B—Payments to Providers VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S1655.IS S1655 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •S 1655 IS Sec. 611. Payments to institutional providers based on global budgets. Sec. 612. Payments to individual providers through fee-for-service. Sec. 613. Accurate valuation of services under the Medicare physician fee schedule. Sec. 614. Payments for prescription drugs and approved devices and equip- ment. Sec. 615. Payment prohibitions; capital expenditures; special projects. Sec. 616. Office of Health Equity. Sec. 617. Office of Primary Health Care. TITLE VII—MEDICARE FOR ALL TRUST FUND Sec. 701. Medicare for All 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 Medicare for All 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 Federal and State Exchanges. TITLE X—TRANSITION TO MEDICARE FOR ALL Subtitle A—Improvements to Medicare Sec. 1001. Protecting Medicare fee-for-service beneficiaries from high out-of- pocket costs. Sec. 1002. Reducing Medicare part D annual out-of-pocket threshold. Sec. 1003. Expanding Medicare to cover dental and vision services and hearing aids and examinations under part B. Sec. 1004. Eliminating the 24-month waiting period for Medicare coverage for individuals with disabilities. Sec. 1005. Guaranteed issue of Medigap policies. Subtitle B—Temporary Medicare Buy-In Option and Temporary Public Option Sec. 1011. Lowering the Medicare age. Sec. 1012. Establishment of the Medicare transition plan. Subtitle C—Patient Protections During Medicare for All Transition Period Sec. 1021. Minimizing disruptions to patient care. Sec. 1022. Public consultation. Sec. 1023. Definitions. TITLE XI—MISCELLANEOUS Sec. 1101. Updating resource limits for Supplemental Security Income eligi- bility (SSI). Sec. 1102. Definitions. VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\S1655.IS S1655 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •S 1655 IS TITLE I—ESTABLISHMENT OF 1 THE MEDICARE FOR ALL PRO- 2 GRAM; UNIVERSAL ENTITLE- 3 MENT TO BENEFITS; ENROLL- 4 MENT 5 SEC. 101. ESTABLISHMENT OF THE MEDICARE FOR ALL 6 PROGRAM. 7 There is hereby established a national health insur- 8 ance program (referred to in this Act as the ‘‘Medicare 9 for All Program’’) to provide comprehensive protection 10 against the costs of health care and health-related items 11 and services, in accordance with the standards specified 12 in, or established under, this Act. 13 SEC. 102. UNIVERSAL ENTITLEMENT TO BENEFITS. 14 (a) IN GENERAL.—Every individual who is a resident 15 of the United States is entitled to benefits for health care 16 items and services under this Act. The Secretary shall pro- 17 mulgate a rule that provides criteria for determining resi- 18 dency for eligibility purposes under this Act. 19 (b) TREATMENT OF OTHER INDIVIDUALS.—The Sec- 20 retary— 21 (1) may make eligible for benefits for health 22 care items and services under this Act other individ- 23 uals not described in subsection (a) and regulate 24 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1655.IS S1655 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •S 1655 IS their eligibility to ensure that every person in the 1 United States has access to health care; and 2 (2) shall promulgate a rule, consistent with 3 Federal immigration laws, to prevent an individual 4 from traveling to the United States for the sole pur- 5 pose of obtaining health care items and services pro- 6 vided under this Act. 7 SEC. 103. FREEDOM OF CHOICE. 8 Any individual entitled to benefits under this Act may 9 obtain health care items and services from any institution, 10 agency, or individual qualified to participate under this 11 Act. 12 SEC. 104. NON-DISCRIMINATION. 13 (a) IN GENERAL.—No person shall, on the basis of 14 race, color, national origin, age, disability, marital status, 15 citizenship status, primary language use, genetic condi- 16 tions, previous or existing medical conditions, religion, or 17 sex, including sex stereotyping, gender identity, sexual ori- 18 entation, and pregnancy and related medical conditions 19 (including termination of pregnancy), be excluded from 20 participation in or be denied the benefits of the program 21 established under this Act (except as expressly authorized 22 by this Act for purposes of enforcing eligibility standards 23 described in section 102), or be subject to any reduction 24 of benefits or other discrimination by any participating 25 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1655.IS S1655 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •S 1655 IS provider (as described in section 301(a)), or any entity 1 conducting, administering, or funding a health program 2 or activity, including contracts of insurance, pursuant to 3 this Act. 4 (b) CLAIMS OF DISCRIMINATION.— 5 (1) IN GENERAL.—The Secretary shall establish 6 a procedure for adjudication of administrative com- 7 plaints alleging a violation of subsection (a). 8 (2) JURISDICTION.—Any person aggrieved by a 9 violation of subsection (a) may file suit in any dis- 10 trict court of the United States having jurisdiction 11 of the parties. A person may bring an action under 12 this paragraph concurrently with such administra- 13 tive remedies as established in paragraph (1). 14 (3) DAMAGES.—If the court finds a violation of 15 subsection (a), the court may grant compensatory 16 and punitive damages (including damages for emo- 17 tional harm), declaratory relief, injunctive relief, at- 18 torneys’ fees and costs, or other relief as appro- 19 priate. 20 (c) CONTINUED APPLICATION OF LAWS.—Nothing in 21 this title shall be construed to invalidate or otherwise limit 22 any of the rights, remedies, procedures, or legal standards 23 available to individuals aggrieved under other Federal 24 laws, including section 1557 of the Patient Protection and 25 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1655.IS S1655 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •S 1655 IS Affordable Care Act (42 U.S.C. 18116), title VI of the 1 Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title 2 VII of the Civil Rights Act of 1964 (42 U.S.C. 2000e et 3 seq.), title IX of the Education Amendments of 1972 (20 4 U.S.C. 1681 et seq.), section 504 of the Rehabilitation Act 5 of 1973 (29 U.S.C. 794), title II of the Americans with 6 Disabilities Act of 1990 (42 U.S.C. 12131 et seq.), or the 7 Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.). 8 Nothing in this title shall be construed to supersede State 9 laws that provide additional protections against discrimi- 10 nation on any basis described in subsection (a). 11 SEC. 105. ENROLLMENT. 12 (a) IN GENERAL.—The Secretary shall provide a 13 mechanism for the enrollment of individuals eligible for 14 benefits under the Medicare for All Program. The mecha- 15 nism shall— 16 (1) include a process for the automatic enroll- 17 ment of individuals at the time of birth in the 18 United States (or upon establishment of residency in 19 the United States); 20 (2) provide for the enrollment, as of the date 21 described in subsection (a) or (b), as applicable, of 22 section 106, of all individuals who are eligible to be 23 enrolled as of such applicable date; and 24 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1655.IS S1655 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •S 1655 IS (3) include a process for the enrollment of indi- 1 viduals made eligible for health care items and serv- 2 ices under section 102(b). 3 (b) ISSUANCE OF MEDICARE FOR ALL CARDS.—In 4 conjunction with an individual’s enrollment for benefits 5 under this Act, the Secretary shall provide for the issuance 6 of a Medicare for All card that shall be used for purposes 7 of identification and processing of claims for benefits 8 under the Medicare for All Program. The card shall not 9 include an individual’s Social Security number. 10 SEC. 106. EFFECTIVE DATE OF BENEFITS. 11 (a) IN GENERAL.—Except as provided in subsection 12 (b), benefits shall first be available under the Medicare 13 for All Program for items and services furnished on Janu- 14 ary 1 of the fourth calendar year that begins after the 15 date of enactment of this Act. 16 (b) IMMEDIATE COVERAGE OF CHILDREN.— 17 (1) IN GENERAL.—For any eligible individual 18 under section 102 who has not yet attained the age 19 of 19 as of the date that is 1 year after the date 20 of enactment of this Act, benefits shall first be avail- 21 able under the Medicare for All Program for items 22 and services furnished on January 1 of the first cal- 23 endar year that begins after the date of enactment 24 of this Act. 25 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1655.IS S1655 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •S 1655 IS (2) OPTION TO CONTINUE IN OTHER COVERAGE 1 DURING TRANSITION PERIOD.—Any person who is 2 eligible to receive benefits as described in paragraph 3 (1) may opt to maintain any coverage described in 4 section 901, private health insurance coverage, or 5 coverage offered pursuant to subtitle A of title X 6 (including the amendments made by such subtitle) 7 until the date on which benefits are first available 8 under subsection (a). 9 SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE. 10 (a) IN GENERAL.—Beginning on the date on which 11 benefits are first available under section 106(a), it shall 12 be unlawful for— 13 (1) a private health insurer to sell health insur- 14 ance coverage that duplicates the benefits provided 15 under the Medicare for All Program; or 16 (2) an employer to provide benefits for an em- 17 ployee, former employee, or the dependents of an 18 employee or former employee that duplicate the ben- 19 efits provided under the Medicare for All Program. 20 (b) CONSTRUCTION.—Nothing in this Act shall be 21 construed as prohibiting the sale of health insurance cov- 22 erage for any additional benefits not covered by the Medi- 23 care for All Program, including additional benefits that 24 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1655.IS S1655 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •S 1655 IS an employer may provide to employees or their depend- 1 ents, or to former employees or their dependents. 2 TITLE II—COMPREHENSIVE BEN- 3 EFITS, INCLUDING BENEFITS 4 FOR LONG-TERM CARE 5 SEC. 201. COMPREHENSIVE BENEFITS. 6 (a) IN GENERAL.—Subject to the other provisions of 7 this title and titles IV through IX, individuals enrolled for 8 benefits under the Medicare for All Program are entitled 9 to have payment made by the Secretary to a participating 10 provider for the following items and services if medically 11 necessary or appropriate for the maintenance of health or 12 for the diagnosis, treatment, or rehabilitation of a health 13 condition: 14 (1) Hospital services, including inpatient and 15 outpatient hospital care, including 24-hour-a-day 16 emergency services and inpatient prescription drugs. 17 (2) Ambulatory patient services. 18 (3) Primary and preventive services, including 19 chronic disease management. 20 (4) Prescription drugs and medical devices, in- 21 cluding outpatient prescription drugs, biological 22 products, and medical devices, and all contraceptive 23 items approved by the Food and Drug Administra- 24 tion. 25 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1655.IS S1655 pbinns [Text truncated for display. 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