Medicare for All Act

I 118TH CONGRESS 1ST SESSION H. R. 3421 To establish an improved Medicare for All national health insurance program. IN THE HOUSE OF REPRESENTATIVES MAY 17, 2023 Ms. JAYAPAL (for herself, Mrs. DINGELL, Ms. ADAMS, Ms. BALINT, Ms. BARRAGA´N, Mr. BEYER, Mr. BLUMENAUER, Ms. BONAMICI, Mr. BOW- MAN, Mr. BOYLE of Pennsylvania, Ms. BROWN, Ms. BUSH, Mr. CARBAJAL, Mr. CA´RDENAS, Mr. CARSON, Mr. CARTER of Louisiana, Mr. CARTWRIGHT, Mr. CASAR, Mrs. CHERFILUS-MCCORMICK, Ms. CHU, Mr. CICILLINE, Ms. CLARKE of New York, Mr. CLEAVER, Mr. COHEN, Ms. CROCKETT, Mr. DAVIS of Illinois, Ms. DEGETTE, Mr. DELUZIO, Mr. DESAULNIER, Mr. DOGGETT, Ms. ESCOBAR, Mr. ESPAILLAT, Mrs. FOUSHEE, Ms. LOIS FRANKEL of Florida, Mr. FROST, Mr. GARAMENDI, Mr. ROBERT GARCIA of California, Mr. GARCI´A of Illinois, Mr. GOLDMAN of New York, Mr. GOMEZ, Mr. GREEN of Texas, Mr. GRIJALVA, Mr. HARDER of California, Mrs. HAYES, Mr. HIGGINS of New York, Ms. HOYLE of Oregon, Mr. HUFFMAN, Mr. IVEY, Mr. JACKSON of Illinois, Ms. JACKSON LEE, Ms. JACOBS, Mr. JOHNSON of Georgia, Ms. KAMLAGER-DOVE, Mr. KEATING, Ms. KELLY of Illinois, Mr. KHANNA, Ms. LEE of California, Ms. LEE of Pennsylvania, Ms. LEGER FERNANDEZ, Mr. LEVIN, Mr. LIEU, Ms. MCCOLLUM, Mr. MCGARVEY, Mr. MCGOVERN, Mr. MEEKS, Ms. MENG, Mr. MFUME, Mr. MULLIN, Mr. NADLER, Mrs. NAPOLITANO, Mr. NEGUSE, Ms. NORTON, Ms. OCASIO- CORTEZ, Ms. OMAR, Mr. PALLONE, Mr. PANETTA, Mr. PAYNE, Ms. PIN- GREE, Mr. POCAN, Ms. PORTER, Ms. PRESSLEY, Mr. QUIGLEY, Mrs. RA- MIREZ, Mr. RASKIN, Mr. SABLAN, Ms. SALINAS, Ms. SA´NCHEZ, Mr. SAR- BANES, Ms. SCHAKOWSKY, Mr. SCHIFF, Mr. SCOTT of Virginia, Mr. SHERMAN, Mr. SMITH of Washington, Ms. STANSBURY, Mr. SWALWELL, Mr. TAKANO, Mr. THANEDAR, Mr. THOMPSON of California, Mr. THOMP- SON of Mississippi, Ms. TITUS, Ms. TLAIB, Ms. TOKUDA, Mr. TONKO, Mr. TORRES of New York, Mrs. TRAHAN, Mr. VARGAS, Ms. VELA´ZQUEZ, Ms. WATERS, Mrs. WATSON COLEMAN, Ms. WILD, Ms. WILLIAMS of Georgia, Ms. WILSON of Florida, and Ms. LOFGREN) introduced the fol- lowing bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committees on Ways and Means, Education and the Workforce, Rules, Oversight and Accountability, Armed Services, and the Judiciary, for a period to be subsequently determined by the VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H3421.IH H3421 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3421 IH Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To establish an improved Medicare for All national health insurance program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Medicare for All Act’’. 5 (b) TABLE OF CONTENTS.—The table of contents of 6 this Act is as follows: 7 Sec. 1. Short title; table of contents. TITLE I—ESTABLISHMENT OF THE MEDICARE FOR ALL PROGRAM; UNIVERSAL COVERAGE; ENROLLMENT Sec. 101. Establishment of the Medicare for All Program. Sec. 102. Universal coverage. Sec. 103. Freedom of choice. Sec. 104. Non-discrimination. Sec. 105. Enrollment. Sec. 106. Effective date of benefits. Sec. 107. Prohibition against duplicating coverage. TITLE II—COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE BENEFITS AND BENEFITS FOR LONG-TERM CARE Sec. 201. Comprehensive benefits. Sec. 202. No cost-sharing; other limitations. Sec. 203. Exclusions and limitations. Sec. 204. Coverage of long-term care services. TITLE III—PROVIDER PARTICIPATION Sec. 301. Provider participation and standards; whistleblower protections. Sec. 302. Qualifications for providers. Sec. 303. Use of private contracts. TITLE IV—ADMINISTRATION VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H3421.IH H3421 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3421 IH 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 the Medicare for All 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 providers based on global budgets. Sec. 612. Payment to individual providers through fee-for-service. Sec. 613. Ensuring accurate valuation of services under the Medicare physician fee schedule. Sec. 614. Payment prohibitions; capital expenditures; special projects. Sec. 615. Office of Health Equity. Sec. 616. Office of Primary Care. Sec. 617. Payments for prescription drugs and approved devices and equip- ment. 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 Medicare for All Program; coordination in case of workers’ compensation. Sec. 802. Application of continuation coverage requirements under ERISA and certain 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. Sec. 903. Sunset of provisions related to pay for performance programs. TITLE X—TRANSITION VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\H3421.IH H3421 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3421 IH Subtitle A—Medicare for All Transition Over 2 Years and Transitional Buy- In Option Sec. 1001. Medicare for all transition over two years. Sec. 1002. Establishment of the Medicare transition buy-in. Subtitle B—Transitional Medicare Reforms Sec. 1011. Eliminating the 24-month waiting period for Medicare coverage for individuals with disabilities. Sec. 1012. Ensuring continuity of care. TITLE XI—MISCELLANEOUS Sec. 1101. Definitions. Sec. 1102. Rules of construction. Sec. 1103. No use of resources for law enforcement of certain registration re- quirements. TITLE I—ESTABLISHMENT OF 1 THE MEDICARE FOR ALL PRO- 2 GRAM; UNIVERSAL COV- 3 ERAGE; ENROLLMENT 4 SEC. 101. ESTABLISHMENT OF THE MEDICARE FOR ALL 5 PROGRAM. 6 There is hereby established a national health insur- 7 ance program to provide comprehensive protection against 8 the costs of health care and health-related services, in ac- 9 cordance with the standards specified in, or established 10 under, this Act. 11 SEC. 102. UNIVERSAL COVERAGE. 12 (a) IN GENERAL.—Every individual who is a resident 13 of the United States is entitled to benefits for health care 14 services under this Act. The Secretary shall promulgate 15 a rule that provides criteria for determining residency for 16 eligibility purposes under this Act. 17 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3421.IH H3421 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3421 IH (b) TREATMENT OF OTHER INDIVIDUALS.—The Sec- 1 retary may make eligible for benefits for health care serv- 2 ices under this Act other individuals not described in sub- 3 section (a), and regulate the eligibility of such individuals, 4 to ensure that every person in the United States has ac- 5 cess to health care. In regulating such eligibility, the Sec- 6 retary shall ensure that individuals are not allowed to 7 travel to the United States for the sole purpose of obtain- 8 ing health care items and services provided under the pro- 9 gram established under this Act. 10 SEC. 103. FREEDOM OF CHOICE. 11 Any individual entitled to benefits under this Act may 12 obtain health services from any institution, agency, or in- 13 dividual qualified to participate under this Act. 14 SEC. 104. NON-DISCRIMINATION. 15 (a) IN GENERAL.—No person shall, on the basis of 16 race, color, national origin, age, disability, marital status, 17 citizenship status, primary language use, genetic condi- 18 tions, previous or existing medical conditions, religion, or 19 sex, including sex stereotyping, gender identity, sexual ori- 20 entation, and pregnancy and related medical conditions 21 (including termination of pregnancy), be excluded from 22 participation in or be denied the benefits of the program 23 established under this Act (except as expressly authorized 24 by this Act for purposes of enforcing eligibility standards 25 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3421.IH H3421 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 3421 IH described in section 102), or be subject to any reduction 1 of benefits or other discrimination by any participating 2 provider (as defined in section 301), or any entity con- 3 ducting, administering, or funding a health program or 4 activity, including contracts of insurance, pursuant to this 5 Act. 6 (b) CLAIMS OF DISCRIMINATION.— 7 (1) IN GENERAL.—The Secretary shall establish 8 a procedure for adjudication of administrative com- 9 plaints alleging a violation of subsection (a). 10 (2) JURISDICTION.—Any person aggrieved by a 11 violation of subsection (a) by a covered entity may 12 file suit in any district court of the United States 13 having jurisdiction of the parties. A person may 14 bring an action under this paragraph concurrently 15 as such administrative remedies as established in 16 paragraph (1). 17 (3) DAMAGES.—If the court finds a violation of 18 subsection (a), the court may grant compensatory 19 and punitive damages, declaratory relief, injunctive 20 relief, attorneys’ fees and costs, or other relief as ap- 21 propriate. 22 (c) CONTINUED APPLICATION OF LAWS.—Nothing in 23 this title (or an amendment made by this title) shall be 24 construed to invalidate or otherwise limit any of the rights, 25 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3421.IH H3421 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 3421 IH remedies, procedures, or legal standards available to indi- 1 viduals aggrieved under section 1557 of the Patient Pro- 2 tection and Affordable Care Act (42 U.S.C. 18116), title 3 VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et 4 seq.), title VII of the Civil Rights Act of 1964 (42 U.S.C. 5 2000e et seq.), title IX of the Education Amendments of 6 1972 (20 U.S.C. 1681 et seq.), section 504 of the Reha- 7 bilitation Act of 1973 (29 U.S.C. 794), or the Age Dis- 8 crimination Act of 1975 (42 U.S.C. 611 et seq.). Nothing 9 in this title (or an amendment to this title) shall be con- 10 strued to supersede State laws that provide additional pro- 11 tections against discrimination on any basis described in 12 subsection (a). 13 SEC. 105. ENROLLMENT. 14 (a) IN GENERAL.—The Secretary shall provide a 15 mechanism for the enrollment of individuals eligible for 16 benefits under this Act. The mechanism shall— 17 (1) include a process for the automatic enroll- 18 ment of individuals at the time of birth in the 19 United States (or upon establishment of residency in 20 the United States); 21 (2) provide for the enrollment, as of the dates 22 described in section 106, of all individuals who are 23 eligible to be enrolled as of such dates, as applicable; 24 and 25 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3421.IH H3421 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 3421 IH (3) include a process for the enrollment of indi- 1 viduals made eligible for health care services under 2 section 102(b). 3 (b) ISSUANCE OF UNIVERSAL MEDICARE CARDS.— 4 In conjunction with an individual’s enrollment for benefits 5 under this Act, the Secretary shall provide for the issuance 6 of a Universal Medicare card that shall be used for pur- 7 poses of identification and processing of claims for bene- 8 fits under this program. The card shall not include an in- 9 dividual’s Social Security number. 10 SEC. 106. EFFECTIVE DATE OF BENEFITS. 11 (a) IN GENERAL.—Except as provided in subsection 12 (b), benefits shall first be available under this Act for 13 items and services furnished 2 years after the date of the 14 enactment of this Act. 15 (b) COVERAGE FOR CERTAIN INDIVIDUALS.— 16 (1) IN GENERAL.—For any eligible individual 17 who— 18 (A) has not yet attained the age of 19 as 19 of the date that is 1 year after the date of the 20 enactment of this Act; or 21 (B) has attained the age of 55 as of the 22 date that is 1 year after the date of the enact- 23 ment of this Act, 24 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3421.IH H3421 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 3421 IH benefits shall first be available under this Act for 1 items and services furnished as of such date. 2 (2) OPTION TO CONTINUE IN OTHER COVERAGE 3 DURING TRANSITION PERIOD.—Any person who is 4 eligible to receive benefits as described in paragraph 5 (1) may opt to maintain any coverage described in 6 section 901, private health insurance coverage, or 7 coverage offered pursuant to subtitle A of title X 8 (including the amendments made by such subtitle) 9 until the date described in subsection (a). 10 SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE. 11 (a) IN GENERAL.—Beginning on the effective date 12 described in section 106(a), it shall be unlawful for— 13 (1) a private health insurer to sell health insur- 14 ance coverage that duplicates the benefits provided 15 under this Act; 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 this Act. 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 this Act, 23 including additional benefits that an employer may provide 24 VerDate Sep 11 2014 23:25 Jun 12, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3421.IH H3421 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 3421 IH to employees or their dependents, or to former employees 1 or their dependents. 2 TITLE II—COMPREHENSIVE BEN- 3 EFITS, INCLUDING PREVEN- 4 TIVE BENEFITS AND BENE- 5 FITS FOR LONG-TERM CARE 6 SEC. 201. COMPREHENSIVE BENEFITS. 7 (a) IN GENERAL.—Subject to the other provisions of 8 this title and titles IV [Text truncated for display. Full text available on Congress.gov.]