This bill would create a single national health insurance program called the Medicare for All Program, providing universal, comprehensive health care coverage for all residents of the United States. Benefits would be delivered through the Secretary of Health and Human Services, covering a broad array of services (hospital care, primary and preventive care, mental health, reproductive care, long-term care, dental/vision/hearing, telehealth, and more) with no patient cost-sharing for most items. Enrollment would be automatic at birth (or upon establishing residency) and a new Medicare for All Card would be issued for claims processing and identification. The bill also sets up a new federal budget and funding structures (including a Medicare for All Trust Fund) and creates oversight, quality, and anti-fraud measures, while permitting states to offer additional benefits and prohibiting duplicative private coverage once benefits under Medicare for All begin. The bill would phase in benefits over several years (with immediate coverage for children under 19 at a date close to enactment) and would sunset or replace many elements of current Federal health programs and the Federal and State Exchanges. It includes transition tools (public options, temporary buy-in) and transition protections for patients and providers, while imposing standards for providers, reimbursement methods, and program administration. It also places emphasis on reducing disparities and expanding access to care, including long-term care and home- and community-based services.
Key Points
- 1Establishes a national Medicare for All Program with universal entitlement to comprehensive health benefits for all U.S. residents, financed through a new federal budget/trust fund and administered by the federal government; enrollment includes automatic birth-era enrollment and a new Medicare for All Card (no Social Security number on the card).
- 2Provides comprehensive benefits with no patient cost-sharing for most services, including hospital care, primary and preventive care, mental health and substance use treatment, reproductive health (including abortion and contraception), oral/vision/auditory care, long-term and home- and community-based care, telehealth, and more; there are defined limits on cost-sharing for prescription drugs (up to $200/year per person, with income-based exemptions) and a prohibition on balance billing.
- 3Prohibits private insurers from duplicating Medicare for All benefits once benefits begin, but allows private coverage for additional benefits not covered by the program; permits automatic enrollment for eligible individuals and restricts private coverage to non-covered benefits or to transitional arrangements during the transition period.
- 4Establishes a provider participation framework requiring a participation agreement, ethics duties, reporting, non-discrimination, and prohibitions on certain financial arrangements to prevent conflicts of interest; provides whistleblower protections and penalties for fraud and abuse; permits termination of participation for noncompliance under defined processes.
- 5Creates Title VI and related provisions for budget and payments, including global budgets for institutional providers and fee-for-service payments for individual providers, with mechanisms to ensure accuracy of payments, modernization of the physician fee schedule, drug/device payments, and a new Office of Health Equity and Office of Primary Health Care; includes quality standards and efforts to address health care disparities.
- 6Includes transition provisions (Title X) such as improvements to Medicare, temporary buy-in and public option, and protections for patients during the transition; provides for conformity amendments to ERISA and related laws, and sunsets the existing Federal and State Exchanges as Medicare for All begins.