Medicare for All Act

This title establishes the 'Medicare for All Program' as a national health insurance program, guaranteeing universal coverage for all U.S. residents. It ensures freedom of choice for individuals to obtain services from any qualified provider and prohibits discrimination in the provision of benefits. Crucially, it makes it unlawful for private health insurers or employers to offer coverage that duplicates benefits provided under this Act, effectively phasing out most private health insurance for covered services after a two-year transition.

This title outlines a comprehensive benefits package, including hospital services, ambulatory care, primary and preventive services, prescription drugs, mental health and substance use treatment, laboratory and diagnostic services, reproductive care (including abortion and gender-affirming care), maternity and newborn care, oral health, audiology, vision, rehabilitative services, emergency services, and long-term care. It explicitly prohibits any cost-sharing (deductibles, copayments, coinsurance), balance billing, or prior authorization requirements for covered services. The Secretary is mandated to annually evaluate and recommend improvements to the benefits package.

This title outlines the requirements for healthcare providers to participate in the Medicare for All program, including licensing, non-discrimination, and uniform reporting standards. It establishes a 'duty of provider ethics' prohibiting financial incentives based on patient utilization or financial outcomes, and bans board members/executives of institutional providers from having financial interests in entities contracting with the provider. Significantly, it prohibits participating providers from entering into private contracts with eligible individuals for covered services, effectively preventing a parallel private market for core medical care. Non-participating providers can enter private contracts for covered services, but must sign an affidavit foregoing Medicare for All payments for two years.

This title establishes a national health budget, allocated annually by the Secretary into components like operating, capital, and special projects budgets, with regional allotments. Institutional providers (hospitals, skilled nursing facilities) will be paid through global budgets negotiated annually with regional directors, covering all operating expenses. Individual providers will be paid via a national fee-for-service schedule. The title explicitly prohibits payments for marketing, profit, incentive payments, and political contributions. It also establishes an Office of Health Equity and an Office of Primary Care. A key provision mandates the Secretary to negotiate prescription drug prices annually, with a 'competitive licensing authority' to allow generic manufacturing if negotiations fail, based on factors including R&D investment and comparative effectiveness.

This section establishes the Universal Medicare Trust Fund in the U.S. Treasury to finance the Medicare for All Program. It mandates appropriations into this fund from the net increase in revenues attributable to the elimination of duplicative employee benefits (under ERISA) and the sunset of State Exchanges. It also appropriates amounts equivalent to current federal spending on Medicare, Medicaid, FEHBP, TRICARE's purchased care, and other federal health programs, adjusted annually. Crucially, it states that existing restrictions on federal funds for reproductive health services shall not apply to monies in this Trust Fund.

This title amends the Employee Retirement Income Security Act of 1974 (ERISA) to prohibit employee benefit plans from providing benefits that duplicate those offered under the Medicare for All Act, reinforcing the elimination of private insurance for covered services. It also mandates that workers' compensation carriers reimburse the Medicare for All Program for the cost of services provided to injured workers, ensuring that the new program is not burdened by existing workers' compensation liabilities. Continuation coverage requirements under ERISA (like COBRA) would only apply to health plans offering non-duplicative benefits.

This title mandates the sunset of major existing federal health programs for individuals eligible for Medicare for All, including Medicare (Title XVIII), Medicaid (Title XIX), and the State Children's Health Insurance Program (SCHIP, Title XXI). It also terminates the Federal Employees Health Benefits Program (FEHBP) and the purchased care component of the TRICARE program (with an exception for TRICARE Overseas). The Federal and State Exchanges established under the Affordable Care Act are terminated, along with all federal pay-for-performance and value-based purchasing programs. Special provisions ensure continuity of care during the transition for inpatient and extended care services and maintain school-related health programs.

This title outlines a two-year transition period for the full implementation of Medicare for All. During the first year, individuals aged 18 and younger, or 55 and older, become eligible for Medicare for All benefits. It also establishes a 'Medicare Transition Buy-In' option, available through the Affordable Care Act Exchanges, allowing any U.S. resident to purchase coverage under the new Medicare for All benefit structure during the transition period. This buy-in provides comprehensive benefits with no cost-sharing and uses Medicare for All reimbursement rates. Tax credits and cost-sharing subsidies are made available for buy-in enrollees, including enhanced subsidies for those in non-Medicaid expansion states. The title also eliminates the 24-month waiting period for Medicare coverage for individuals with disabilities during this transition and ensures continuity of care for all persons, especially those with complex medical needs.