S. 1218 (Kennedy)/H.R. 2034 (Dingell)

Name of new program
Medicare For All

Target population(s)
All U.S. citizens and legal residents (except those entitled to Medicare).

Eligibility
Eligibility would be phased-in by age cohorts. Eligible individuals during the first 2 years would include those under 25 and over 55 years of age. In the next 2 year period, eligible individuals would include those under 35 and over 45 years of age. In the 5th year, all citizens and legal residents would be eligible. During the phase-in period, individuals already enrolled in Medicare For All would remain enrolled even if they reached an age that would otherwise not yet qualify for eligibility. Upon becoming eligible for Medicare For All, enrollment would be automatic and would apply, at the same time and using a common enrollment form, to immediate family members. The requirements of this bill would not affect the obligations of employers to provide or fund health benefits under any group health plan established under a collective bargaining agreement in effect on the date of enactment. The Medicare For All program would not apply to eligible individuals who are covered by a group health plan until the collective bargaining agreement was terminated. Consistent with a collective bargaining agreement, an employer could limit coverage under its plan to individuals who are not eligible for benefits under Medicare For All.

Types of coverage
Coverage under Medicare For All would be available through a Medicare-run program similar to the traditional Medicare fee-for-service program. Beneficiary protections, provider reimbursement rates (with additional payments for quality), and other aspects of program administration would be similar to Medicare fee-for-service.

Benefits under Medicare For All would include those covered under Medicare Parts A and B, prescription drug benefits at least equal to such coverage under the Blue Cross Blue Shield Standard Plan of the FEHBP (2007), Medicaid EPSDT benefits, preventive benefits, home and community-based benefits, and such additional benefits approved by the Secretary of HHS. The Secretary would have the authority to improve benefits based on periodic evaluations of what is necessary or advisable to promote the health of beneficiaries under the program. Cost-sharing would be the same as prescribed for Medicare, except that prescription drug cost sharing would be the same as applicable to that imposed in the FEHBP Blue Cross Blue Shield Standard Plan. Nominal cost-sharing could be imposed on EPSDT and home and community-based services consistent with Medicaid policy. Beneficiaries would have the freedom to choose their own doctors and other providers.

The Secretary of HHS would also be required to contract with private plans to offer Medicare For All benefits in a manner similar to Medicare Advantage or FEHBP. Plan benefits would have to be similar to or no less than those provided in any of the four largest health plans (in terms of enrollment) offered under the FEHBP. Such plans also could offer additional benefits (for a premium). The private plans would be required to offer an annual open enrollment period. The Secretary would pay these plans a monthly capitation amount for each enrollee, adjusted for the relative risk factors of their enrollees. As a condition of participating in FEHBP, private plans would be required to offer a separate plan under Medicare For All on similar terms and conditions but with a separate risk pool.

Medicare would remain separate from the new program. Eligible individuals also entitled to coverage under Medicaid, SCHIP, DOD programs, Veterans health care, or the Indian Health Service could still elect coverage under those programs. Such public programs would be secondary payers to the Medicare For All program. To maintain eligibility for Federal Medicaid matching payments, states could not reduce their Medicaid eligibility standards or benefits or increase cost-sharing requirements that were in effect on the date of this bill's enactment.

Premiums
The Secretary would be required to establish family premiums for the Medicare-run program. Otherwise, no premiums would be charged except that premiums could be imposed by private health plans that contract to provide benefits under Medicare For All.

Government subsidiaries
Public funds would cover all costs except for allowed deductibles and cost-sharing. Cost-sharing would be reduced to Medicaid levels for low income individuals.

Financing
Financing would be based on 1.7% tax on the wages in excess of $25,000 (indexed after 2008 by the CPI-urban) of individuals who are enrolled in Medicare For All (or have a family member who is so enrolled). In addition, a 7% excised tax would be imposed on wages, to be paid by employers of individuals who are enrolled in Medicare For All (or a member of the employee's family is so enrolled). Individuals who are self-employed and enrolled in Medicare For All would pay a new self-employment wage tax.

Effective date
Enactment. The financing provisions (new taxes) would apply to wages paid and income derived on or after January 1 of the year following enactment.

Administration
The Secretary would be required to provide for the offering of benefits under Medicare for All through a program similar to Medicare fee-for-service and through enrollment in private plans that meet the requirements of this bill. The Secretary, with the assistance of the Medicare Payment Advisory Commission, would be required to develop and implement a payment schedule for benefits covered under Medicare For All through the government-administered program, and also to provide for reimbursement to providers that achieves measures of quality and appropriate use of health information technology.

Other provisions in bill

By the 6th year of the program, eligibility cards would have to be linked to an individual's electronic health record, with strong privacy protections. Private supplemental health insurance would be permitted. Mental health benefits would have to meet parity requirements related to cost sharing and treatment limitations.