Medicare for All Act

Summary#

This bill would create a national health insurance program called the Medicare for All Program. It would make every resident of the United States eligible for covered health care items and services. The bill lists a wide range of covered benefits, including hospital care, primary and preventive care, prescription drugs, mental health and substance use treatment, maternity and newborn care, comprehensive reproductive care (including abortion and contraception), gender-affirming care, dental, vision, hearing, rehabilitative services, hospice, and long-term services and supports. The program would ban cost-sharing (no deductibles, copays, or coinsurance), ban balance billing, and prohibit prior authorization and step therapy for covered services.

The bill would require providers to apply to participate and meet national and state licensing standards. Institutional providers (like hospitals) would generally be paid by quarterly global budgets negotiated with regional directors. Individual providers would be paid through a national fee schedule. The Secretary of Health and Human Services would set a national health budget, create regional offices, and run a Universal Medicare Trust Fund to receive appropriations and transfers. The Secretary would also negotiate annual prices for covered prescription drugs and has authority to license patents or clinical data to ensure supply if negotiations fail.

The bill phases in benefits over a two-year transition. Benefits generally begin two years after enactment, with some earlier eligibility and a one-year transition buy-in option. The bill also contains numerous administrative provisions: an Office of Health Equity, an Office of Primary Care, a beneficiary ombudsman, quality and data reporting rules, whistleblower protections for providers and workers, and changes to rules for employer-sponsored plans and workers' compensation. It would end many existing federal health program payment rules and would prohibit sale of private insurance that duplicates covered benefits once the program is fully in effect.

What it means for you#

  • If you are a U.S. resident, you would be eligible for covered health care benefits under this program.
  • You would receive a Universal Medicare card for identification and claims, and you would not pay deductibles, copays, coinsurance, or be balance billed for covered services.
  • You could get care from any participating provider who is qualified under the program rules.
  • Certain services listed in the bill (for example, reproductive care, gender-affirming care, mental health, and long-term care) are included as covered benefits.
  • Private health insurers and employers would be prohibited from offering or selling coverage that duplicates benefits provided by this program once it is fully effective; states may offer additional benefits beyond those in the program at their own expense.

Expenses#

  • The bill creates a Universal Medicare Trust Fund to pay for the program. The fund would receive appropriations and transfers from the Treasury, including transfers equivalent to certain increases in revenue from tax and ERISA-related changes described in the bill, and initial transfers that approximate current federal spending on Medicare, Medicaid, the Federal Employees Health Benefits program, parts of TRICARE, and certain other health programs.
  • The Secretary must set an annual national health budget and divide it into operating, capital, special projects, quality, education, administrative, reserve, and public health components. Regional offices receive annual allotments from that budget.
  • The bill specifies budget rules, global budget negotiations, and restrictions on using program funds for profit, marketing, or certain incentive payments.
  • No publicly available information on the bill's total projected costs, savings, or economic effects is provided in the bill text or metadata provided here.

Proponents' View#

  • The bill text frames the proposal as establishing comprehensive protection against the costs of health care and as a way to ensure access to a broad set of services for all residents.
  • The bill expresses a view that removing profit motives and duplicative private coverage will correct deficiencies in the current health system and help provide equitable access to care. It includes new offices and data collection to monitor and address health disparities.
  • The bill also highlights drug price negotiation and, if needed, competitive licensing as tools to make medicines and devices available to the program at negotiated prices.

Opponents' View#

No publicly available information.