II 

109TH CONGRESS 

2D SESSION S. 2229 

To provide quality, affordable health care for all Americans. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 31, 2006 

Mr. KENNEDY introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To provide quality, affordable health care for all Americans. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medicare for All Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Medicare for all. 

‘‘TITLE XXII—MEDICARE FOR ALL 

‘‘Sec. 2201. Description of program. 

‘‘Sec. 2202. Eligibility, enrollment, and coverage. 

‘‘Sec. 2203. Benefits. 

‘‘Sec. 2204. Choice of coverage under private health care delivery systems. 

‘‘Sec. 2205. Medicare for All Trust Fund. 
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‘‘Sec. 2206. Administration. 

Sec. 3. Financing through employment tax. 

1 SEC. 2. MEDICARE FOR ALL. 

2 (a) ESTABLISHMENT OF PROGRAM.—The Social Se3 curity Act is amended by adding at the end the following: 

4 ‘‘TITLE XXII—MEDICARE FOR ALL 

5 ‘‘SEC. 2201. DESCRIPTION OF PROGRAM. 

6 ‘‘The program under this title— 

7 ‘‘(1) ensures that all Americans have high qual8 ity, affordable health care; 

9 ‘‘(2) ensures that all Americans have access to 

10 health care as good as their Member of Congress re11 ceives; and 

12 ‘‘(3) reduces the cost of health care and en13 hances American economic competitiveness in the 

14 global marketplace. 

15 ‘‘SEC. 2202. ELIGIBILITY, ENROLLMENT, AND COVERAGE. 

16 ‘‘(a) ELIGIBILITY.— 

17 ‘‘(1) IN GENERAL.—Each eligible individual is 

18 entitled to benefits under the program under this 

19 title. 

20 ‘‘(2) ELIGIBLE INDIVIDUAL.— 

21 ‘‘(A) IN GENERAL.—For purposes of this 

22 title, the term ‘eligible individual’ means an in23 dividual who— 

24 ‘‘(i) is— 
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1 ‘‘(I) a citizen of the United 

2 States; or 

3 ‘‘(II) a person who is lawfully 

4 present in the United States; and 

5 ‘‘(ii) is not eligible for benefits under 

6 part A or B of title XVIII. 

7 ‘‘(B) LAWFULLY PRESENT.—For purposes 

8 of subparagraph (A)(i)(II), a person is lawfully 

9 present in the United States if such person— 

10 ‘‘(i) is described in section 431 of 

11 Public Law 104–193; 

12 ‘‘(ii) is described in section 103.12 of 

13 title 8, Code of Federal Regulations (as in 

14 effect as of the date of enactment of the 

15 Medicare for All Act); 

16 ‘‘(iii) is eligible to apply for employ17 ment authorization from the Department 

18 of Homeland Security as listed in section 

19 274a.12 of title 8, Code of Federal Regula20 tions (as in effect as of the date of enact21 ment of the Medicare for All Act); or 

22 ‘‘(iv) is otherwise determined to be 

23 lawfully present in the United States under 

24 criteria established by the Secretary, in 
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1 consultation with the Secretary of Home2 land Security. 

3 ‘‘(3) PHASE-IN OF ELIGIBILITY.—Under rules 

4 established by the Secretary, eligibility for benefits 

5 under this title shall be phased-in as follows: 

6 ‘‘(A) During the first 5 years the program 

7 under this title is in operation, eligible individ8 uals who are under 20 years of age or who are 

9 over 55 years of age are eligible for such bene10 fits. 

11 ‘‘(B) During the second 5 years the pro12 gram under this title is in operation, eligible in13 dividuals who are under 30 years of age or who 

14 are over 45 years of age are eligible for such 

15 benefits. 

16 ‘‘(C) All eligible individuals are eligible for 

17 such benefits beginning with the eleventh year 

18 in which the program under this title is in oper19 ation. 

20 ‘‘(b) AUTOMATIC ENROLLMENT.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall estab22 lish a process under which each eligible individual is 

23 deemed to be enrolled under the program under this 

24 title. Such process shall include the following: 
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1 ‘‘(A) Deemed enrollment of an eligible in2 dividual upon birth in the United States. 

3 ‘‘(B) Enrollment of eligible individuals at 

4 the time of immigration into the United States. 

5 ‘‘(2) ISSUANCE OF CARD.—The Secretary shall 

6 provide for issuance of an appropriate card for indi7 viduals entitled to benefits under the program under 

8 this title. Not later than the sixth year the program 

9 under this title is in operation, the Secretary shall 

10 ensure that each such card is linked securely, and 

11 with strong privacy protections, to an electronic 

12 health record for each such individual. In order to 

13 accomplish such linkage, the Secretary is authorized 

14 to award grants, issue contracts, alter reimburse15 ment under the program under this title, or provide 

16 such other incentives as are reasonable and nec17 essary. 

18 ‘‘(c) COVERAGE.— 

19 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

20 the Secretary shall provide for coverage of benefits 

21 for items and services furnished on and after the 

22 date an individual is entitled to benefits under the 

23 program under this title. 

24 ‘‘(2) INITIAL COVERAGE.—No coverage is avail25 able under the program under this title for items 
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1 and services furnished before the date that is 18 

2 months after the date of the enactment of the Medi3 care For All Act. 

4 ‘‘(3) EXPIRATION OF COVERAGE.—An individ5 ual’s coverage under the program under this title 

6 shall terminate as of the date the individual is no 

7 longer an eligible individual. 

8 ‘‘(d) RELATION TO OTHER PROGRAMS.— 

9 ‘‘(1) CONSTRUCTION.— 

10 ‘‘(A) CONTINUED OPERATION OF PUBLIC

11 PROGRAMS.—Nothing in this title shall be con12 strued as requiring (or preventing) an indi13 vidual who is entitled to benefits under the pro14 gram under this title from obtaining benefits 

15 under any other public health care program to 

16 which the individual is entitled, including under 

17 a State Medicaid plan under title XIX, the 

18 State Children’s Health Insurance Program 

19 under title XXI, a health program of the De20 partment of Defense under chapter 55 of title 

21 10, United States Code, a health program of 

22 the Department of Veterans Affairs under 

23 chapter 17 of title 38 of such Code, or a med24 ical care program of the Indian Health Service 

25 or of a tribal organization. 
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1 ‘‘(B) CONTINUED OPERATION OF PRIVATE

2 HEALTH INSURANCE.—Nothing in this title 

3 shall be construed as preventing an individual 

4 who is entitled to benefits under the program 

5 under this title from obtaining benefits that 

6 supplement or improve the benefits available 

7 under such program from any private health in8 surance plan or policy. 

9 ‘‘(2) PRIMARY PAYOR; OTHER PUBLIC PRO10 GRAMS PROVIDING WRAP AROUND BENEFITS.—The 

11 program under this title shall be primary payor to 

12 other public health care benefit programs and the 

13 benefits under such other public health care benefit 

14 programs shall supplement the benefits under the 

15 program under this title. 

16 ‘‘SEC. 2203. BENEFITS. 

17 ‘‘(a) COMPREHENSIVE BENEFIT PACKAGE.—The 

18 Secretary shall provide for benefits under the program 

19 under this title consistent with the following: 

20 ‘‘(1) MEDICARE FEE-FOR-SERVICE BENEFITS.— 

21 The benefits include the full range and scope of ben22 efits available under the original fee-for-service pro23 gram under parts A and B of title XVIII. 

24 ‘‘(2) PRESCRIPTION DRUG COVERAGE.—The 

25 benefits include coverage of prescription drugs at 
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1 least as comprehensive as the prescription drug cov2 erage offered as of January 1, 2006, under the Blue 

3 Cross/Blue Shield Standard Plan provided under the 

4 Federal employees health benefits program under 

5 chapter 89 of title 5, United States Code (in this 

6 title referred to as ‘FEHBP’). Such coverage shall 

7 be administered in the same manner as other bene8 fits under this section. 

9 ‘‘(3) INCLUSION OF EPSDT.—The benefits in10 clude benefits for early and periodic screening, diag11 nostic, and treatment services (as defined in section 

12 1905(r)) for individuals who are under the age of 

13 21. 

14 ‘‘(4) PARITY IN COVERAGE OF MENTAL HEALTH

15 BENEFITS.— 

16 ‘‘(A) IN GENERAL.—There shall not be any 

17 treatment limitations or financial requirements 

18 with respect to the coverage of benefits for 

19 mental illnesses unless comparable treatment 

20 limitations or financial requirements are im21 posed on medical and surgical benefits. Nothing 

22 in this subparagraph shall be construed to re23 quire coverage for mental health benefits that 

24 are not medically necessary or to prohibit the 
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1 appropriate medical management of such bene2 fits. 

3 ‘‘(B) RELATED DEFINITIONS.—For pur4 poses of this paragraph— 

5 ‘‘(i) FINANCIAL REQUIREMENTS.— 

6 The term ‘financial requirements’ includes 

7 deductibles, coinsurance, co-payments, 

8 other cost-sharing, and limitations on the 

9 total amount that may be paid by an indi10 vidual with respect to benefits and shall in11 clude the application of annual and lifetime 

12 limits. 

13 ‘‘(ii) MENTAL HEALTH BENEFITS.— 

14 The term ‘mental health benefits’ means 

15 benefits with respect to services for all cat16 egories of mental health conditions listed 

17 in the Diagnostic and Statistical Manual of 

18 Mental Disorders, Fourth Edition (DSM 

19 IV–TR), or the most recent edition if dif20 ferent than the Fourth Edition, if such 

21 services are included as part of an author22 ized treatment plan that is in accordance 

23 with standard protocols and such services 

24 meet medical necessity criteria. Such term 

25 does not include benefits with respect to 
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1 the treatment of substance abuse or chem2 ical dependency. 

3 ‘‘(iii) TREATMENT LIMITATIONS.— 

4 The term ‘treatment limitations’ means 

5 limitations on the frequency of treatment, 

6 number of visits or days of coverage, or 

7 other similar limits on the duration or 

8 scope of treatment under the qualifying 

9 health benefit plan. 

10 ‘‘(5) PREVENTIVE SERVICES.—The benefits 

11 shall include coverage of such additional preventive 

12 health care items and services as the Secretary shall 

13 specify, in consultation with the United States Pre14 ventive Services Task Force. 

15 ‘‘(6) HOME AND COMMUNITY BASED SERV16 ICES.—The benefits shall include coverage of home 

17 and community-based services described in section 

18 1915(c)(4)(B). 

19 ‘‘(7) ADDITIONAL BENEFITS.—The benefits 

20 shall include such additional benefits that the Sec21 retary determines appropriate. 

22 ‘‘(8) REVISION.—Nothing in this subsection 

23 shall be construed as preventing the Secretary from 

24 improving the benefit package from time to time to 

25 account for changes in medical practice, new infor-
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1 mation from medical research, and other relevant 

2 developments in health science. 

3 ‘‘(9) ADJUSTMENT AUTHORIZED.—The Sec4 retary shall, on a regular basis, evaluate whether 

5 adding any of the benefits described in paragraphs 

6 (1) through (7) is necessary or advisable to promote 

7 the health of beneficiaries under the program under 

8 title XVIII. The Secretary is authorized to improve 

9 the benefits available under such program, based 

10 upon such evaluation. 

11 ‘‘(b) COST-SHARING.— 

12 ‘‘(1) IN GENERAL.—Except as otherwise pro13 vided under this subsection or subsection (a)(4), 

14 with respect to the benefits described in subsection 

15 (a)(1), such benefits shall be subject to the cost16 sharing (in the form of deductibles, coinsurance, and 

17 copayments) and premiums applicable under the 

18 program described in such subsection. 

19 ‘‘(2) PRESCRIPTION DRUG COVERAGE.—With 

20 respect to the benefits described in subsection (a)(2), 

21 such benefits shall be subject to the cost-sharing (in 

22 the form of deductibles, coinsurance, and copay23 ments) applicable under the plan described in such 

24 subsection. 
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1 ‘‘(3) TREATMENT OF PREVENTIVE AND ADDI2 TIONAL SERVICES.—With respect to benefits de3 scribed in paragraphs (5) and (7) of subsection (a), 

4 such benefits shall be subject to cost-sharing (in the 

5 form of deductibles, coinsurance, and copayments) 

6 that is consistent (as determined by the Secretary) 

7 with the cost-sharing applicable under paragraph 

8 (1). 

9 ‘‘(4) TREATMENT OF EPSDT AND HOME AND

10 COMMUNITY-BASED SERVICES.—With respect to ben11 efits described in paragraphs (3) and (6) of sub12 section (a), such benefits shall be subject to nominal 

13 cost-sharing (in the form of deductibles, coinsurance, 

14 and copayments) that is consistent (as determined 

15 by the Secretary) with the cost-sharing applicable to 

16 such services under section 1916 (as in effect on 

17 January 1, 2006). 

18 ‘‘(5) REDUCTION IN COST-SHARING FOR LOW19 INCOME INDIVIDUALS.—The Secretary shall provide 

20 for reduced cost-sharing for low-income individuals 

21 in a manner that is no less protective than the re22 duced cost-sharing for individuals under section 

23 1902(a)(10)(E) (as in effect on January 1, 2006). 

24 ‘‘(c) FREEDOM TO CHOOSE YOUR OWN DOCTOR AND

25 HEALTH PLAN.—Except in the case of individuals who 
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1 elect enrollment in a private health plan under section 

2 2204, the provisions of section 1802 shall apply under this 

3 title. 

4 ‘‘(d) PAYMENT SCHEDULE.— 

5 ‘‘(1) IN GENERAL.—The Secretary, with the as6 sistance of the Medicare Payment Advisory Commis7 sion, shall develop and implement a payment sched8 ule for benefits covered under the program under 

9 this title which are provided other than through pri10 vate health plans. To the extent feasible, such pay11 ment schedule shall be consistent with comparable 

12 payment schedules and reimbursement methodolo13 gies applied to benefits provided under parts A and 

14 B of title XVIII, except, that with respect to the 

15 coverage of prescription drugs, the Secretary shall 

16 provide for payment in accordance with a payment 

17 schedule developed and implemented under the pre18 vious sentence. 

19 ‘‘(2) ADDITIONAL PAYMENTS FOR QUALITY.— 

20 The Secretary shall establish procedures to provide 

21 reimbursement in addition to the reimbursement 

22 under paragraph (1) to health care providers that 

23 achieve measures (as established by the Secretary in 

24 consultation with health care professionals and 

25 groups representing eligible individuals) of health 
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1 care quality. The Secretary shall ensure that such 

2 measures include measures of appropriate use of 

3 health information technology. 

4 ‘‘(e) APPLICATION OF BENEFICIARY PROTEC5 TIONS.—The Secretary shall provide for protections of 

6 beneficiaries under the program under this title that are 

7 not less than the beneficiary protections provided under 

8 title XVIII, including appeal rights and limitations on bal9 ance billing. 

10 ‘‘SEC. 2204. CHOICE OF COVERAGE UNDER PRIVATE 

11 HEALTH CARE DELIVERY SYSTEMS. 

12 ‘‘(a) IN GENERAL.—The Secretary shall provide a 

13 process for— 

14 ‘‘(1) the offering of private health plans for the 

15 provision of benefits under the program under this 

16 title; and 

17 ‘‘(2) the enrollment, disenrollment, termination, 

18 and change in enrollment of eligible individuals in 

19 such plans. 

20 ‘‘(b) OFFERING OF PRIVATE HEALTH PLANS.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall enter 

22 into contracts with qualified entities for the offering 

23 of private health plans under the program under this 

24 title. In entering into such contracts the Secretary 

25 shall have the same authority that the Director of 
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1 the Office of Personnel Management has with re2 spect to health benefits plans under FEHBP. 

3 ‘‘(2) REQUIREMENTS.—The Secretary shall not 

4 enter into such a contract for the offering of a pri5 vate health plan under the program under this title 

6 unless at least the following requirements are met: 

7 ‘‘(A) BENEFITS AS GOOD AS YOUR CON8 GRESSMAN GETS.—Benefits under such plans 

9 are not less than the benefits offered to Mem10 bers of Congress and Federal employees under 

11 FEHBP. Such plans may provide health bene12 fits in addition to such required benefits and 

13 may impose a premium for the provision of ben14 efits. Such plans may not provide for financial 

15 payments or rebates to enrollees. 

16 ‘‘(B) BENEFICIARY PROTECTIONS.—En17 rollees in such plans have beneficiary protec18 tions that are not less than the beneficiary pro19 tections applicable under this title to individuals 

20 not so enrolled and shall include beneficiary 

21 protections applicable under both FEHBP and 

22 part C of title XVIII. 

23 ‘‘(C) OTHER ADMINISTRATIVE REQUIRE24 MENTS.—The plans are subject to such require25 ments relating to licensure and solvency, protec-
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1 tion against fraud and abuse, inspection, disclo2 sure, periodic auditing, and administrative oper3 ations and efficiencies as the Secretary identi4 fies, taking into account similar requirements 

5 under FEHBP and part C of title XVIII. 

6 ‘‘(c) ANNUAL OPEN ENROLLMENT.—The process 

7 under subsection (a)(2) shall provide for an annual open 

8 enrollment period in which individuals may enroll, and 

9 change or terminate enrollment, in private health plans 

10 in a manner similar to that provided under FEHBP as 

11 of January 1, 2006. 

12 ‘‘(d) PAYMENT TO PRIVATE HEALTH PLANS.— 

13 ‘‘(1) IN GENERAL.—In the case of an individual 

14 enrolled in a private health plan under this section 

15 for a month, the Secretary shall provide for payment 

of an amount equal to 1 16 ⁄12 of the annual per capita 

17 amount (described in paragraph (2), as adjusted 

18 under paragraph (3)). 

19 ‘‘(2) ANNUAL PER CAPITA AMOUNT.—The an20 nual per capita amount under this paragraph shall 

21 be the annual average per capita cost of providing 

22 benefits under the program under this title (includ23 ing both individuals enrolled and not enrolled under 

24 private health plan), as computed by the Secretary 
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1 based on rules similar to the rules described in sec2 tion 1876(a)(4). 

3 ‘‘(3) RISK-ADJUSTMENT.—In making payment 

4 under this subsection, the Secretary shall apply risk 

5 adjustment factors similar to those applied to pay6 ments to Medicare Advantage organizations under 

7 section 1853, except that the Secretary shall ensure 

8 that payments under this subsection are adjusted 

9 based on such factors to ensure that the health sta10 tus of the enrollee is reflected in such adjusted pay11 ments, including adjusting for the difference between 

12 the health status of the enrollee and individuals re13 ceiving benefits under the program under this title 

14 who are not so enrolled. Payments under this sub15 section must, in aggregate, reflect such differences. 

16 ‘‘(e) REQUIREMENTS FOR FEHBP CARRIERS.— 

17 Each contract entered into or renewed under section 8902 

18 of title 5, United States Code, shall require the carrier 

19 to offer a plan under this section on similar terms and 

20 conditions to the plan offered by the carrier under 

21 FEHBP. 

22 ‘‘SEC. 2205. MEDICARE FOR ALL TRUST FUND. 

23 ‘‘(a) ESTABLISHMENT OF TRUST FUND.—There is 

24 hereby created on the books of the Treasury of the United 

25 States a trust fund to be known as the ‘Medicare for All 
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1 Trust Fund’ (in this section referred to as the ‘Trust 

2 Fund’). The Trust Fund shall consist of such gifts and 

3 bequests as may be made as provided in section 201(i)(1), 

4 and such amounts as may be deposited in, or appropriated 

5 to, such fund as provided in this part. 

6 ‘‘(b) TRANSFERS TO TRUST FUND.—There are here7 by appropriated to the Medicare for All Trust Fund, out 

8 of any moneys in the Treasury not otherwise appropriated, 

9 amounts equivalent to— 

10 ‘‘(1) the taxes received in the Treasury under 

11 sections 1401(c), 3101(c), and 3111(c) of the Inter12 nal Revenue Code of 1986; 

13 ‘‘(2) such portion of the taxes received in the 

14 Treasury under section 3201 as are attributable to 

15 the rate specified in section 3101(c) of such Code; 

16 ‘‘(3) such portion of the taxes received in the 

17 Treasury under section 3211 of such Code as are at18 tributable to the sum of the rates specified in section 

19 3101(c) and 3111(c) of such Code; and 

20 ‘‘(4) such portion of the taxes received in the 

21 Treasury under section 3221 as are attributable to 

22 the rate specified in section 3111(c) of such Code. 

23 The amounts appropriated by the preceding sentence shall 

24 be transferred from time to time from the general fund 

25 in the Treasury to the Trust Fund, such amounts to be 
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1 determined on the basis of estimates by the Secretary of 

2 the Treasury of the taxes, specified in the preceding sen3 tence, paid to or deposited into the Treasury, and proper 

4 adjustments shall be made in amounts subsequently trans5 ferred to the extent prior estimates were in excess of or 

6 were less than the taxes specified in such sentence. 

7 ‘‘(c) INCORPORATION OF PROVISIONS.— 

8 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

9 subsections (b) through (i) of section 1817 shall 

10 apply with respect to the Trust Fund and this title 

11 in the same manner as they apply with respect to 

12 the Federal Hospital Insurance Trust Fund and 

13 part A of title XVIII, respectively. 

14 ‘‘(2) MISCELLANEOUS REFERENCES.—In apply15 ing provisions of section 1817 under paragraph 

16 (1)— 

17 ‘‘(A) any reference in such section to ‘this 

18 part’ is construed to refer to this title; 

19 ‘‘(B) any reference to taxes referred to in 

20 subsection (a) of such section shall be construed 

21 to refer to the taxes referred to in subsection 

22 (b) of this section; and 

23 ‘‘(C) the Board of Trustees of the Medi24 care for All Trust Fund shall be the same as 
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1 the Board of Trustees of the Federal Hospital 

2 Insurance Trust Fund. 

3 ‘‘SEC. 2206. ADMINISTRATION. 

4 ‘‘Except as otherwise provided in this title— 

5 ‘‘(1) the Secretary shall enter into appropriate 

6 contracts with providers of services, other health 

7 care providers, and medicare administrative contrac8 tors, taking into account the types of contracts used 

9 under title XVIII with respect to such entities, to 

10 administer the program under this title; 

11 ‘‘(2) benefits described in section 2203 that are 

12 payable under the program under this title to such 

13 individuals shall be paid in a manner specified by 

14 the Secretary (taking into account, and based to the 

15 greatest extent practicable upon, the manner in 

16 which they are provided under title XVIII); and 

17 ‘‘(3) provider participation agreements under 

18 title XVIII shall apply to enrollees and benefits 

19 under the program under this title in the same man20 ner as they apply to enrollees and benefits under the 

21 program under title XVIII.’’. 

22 (b) CONFORMING AMENDMENTS TO SOCIAL SECU23 RITY ACT PROVISIONS.— 

24 (1) Section 201(i)(1) of the Social Security Act 

25 (42 U.S.C. 401(i)(1)) is amended— 
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1 (A) by striking ‘‘or the Federal Supple2 mentary ’’ and inserting ‘‘the Federal Supple3 mentary’’; and 

4 (B) by inserting ‘‘or the Medicare for All 

5 Trust Fund’’ after ‘‘such Trust Fund)’’. 

6 (2) Section 201(g)(1)(A) of such Act (42 

7 U.S.C. 401(g)(1)(A)) is amended by striking ‘‘and 

8 the Federal Supplementary Medical Insurance Trust 

9 Fund established by title XVIII’’ and inserting ‘‘, 

10 the Federal Supplementary Medical Insurance Trust 

11 Fund established by title XVIII, and the Medicare 

12 for All Trust Fund established under title XXII’’. 

13 (c) MAINTENANCE OF MEDICAID ELIGIBILITY AND

14 BENEFITS.—In order for a State to continue to be eligible 

15 for payments under section 1903(a) of the Social Security 

16 Act (42 U.S.C. 1396b(a)) the State may not reduce stand17 ards of eligibility or benefits provided under its State Med18 icaid plan under title XIX of the Social Security Act below 

19 such standards of eligibility and benefits in effect on the 

20 date of the enactment of this Act. 

21 SEC. 3. FINANCING THROUGH EMPLOYMENT TAX. 

22 (a) TAX ON EMPLOYEES.—Section 3101 of the Inter23 nal Revenue Code of 1986 is amended by redesignating 

24 subsection (c) as subsection (d) and by inserting after sub25 section (b) the following new subsection: 
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1 ‘‘(c) MEDICARE FOR ALL.—In addition to other 

2 taxes, there is hereby imposed on the income of every indi3 vidual a tax equal to 1.7 percent of the wages (as defined 

4 in section 3121(a)) received by him with respect to em5 ployment (as defined in section 3121(b)).’’. 

6 (b) TAX ON EMPLOYERS.—Section 3111 of such 

7 Code is amended by redesignating subsection (c) as sub8 section (d) and by inserting after subsection (b) the fol9 lowing new subsection: 

10 ‘‘(c) MEDICARE FOR ALL.—In addition to other 

11 taxes, there is hereby imposed on every employer an excise 

12 tax, with respect to having individuals in his employ, equal 

13 to 7 percent of the wages (as defined in section 3121(a)) 

14 paid by him with respect to employment (as defined in 

15 section 3121(b)).’’. 

16 (c) TAX ON SELF-EMPLOYMENT.—Section 1401 of 

17 such Code is amended by redesignating subsection (c) as 

18 subsection (d) and by inserting after subsection (b) the 

19 following new subsection: 

20 ‘‘(c) MEDICARE FOR ALL.—In addition to other 

21 taxes, there shall be imposed for each taxable year, on the 

22 self-employment income of every individual, a tax equal 

23 to the applicable percent of the self-employment income 

24 for such taxable year. For purposes of the preceding sen25 tence, the applicable percent is a percent equal to the sum 
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1 of the percent described in section 3101(c) plus the per2 cent described in section 3111(c).’’. 

3 (d) RAILROAD RETIREMENT TAX.— 

4 (1) TAX ON EMPLOYEES.—Section 3201(a) of 

5 such Code is amended by striking ‘‘subsections (a) 

6 and (b) of section 3101’’ and inserting ‘‘subsections 

7 (a), (b), and (c) of section 3101’’. 

8 (2) TAX ON EMPLOYEE REPRESENTATIVES.— 

9 Section 3211(a) of such Code is amended by striking 

10 ‘‘subsections (a) and (b) of section 3101 and sub11 sections (a) and (b) of section 3111’’ and inserting 

12 ‘‘subsections (a), (b), and (c) of section 3101 and 

13 subsections (a), (b), and (c) of section 3111’’. 

14 (3) TAX ON EMPLOYERS.—Section 3221(a) of 

15 such Code is amended by striking ‘‘subsections (a) 

16 and (b) of section 3111’’ and inserting ‘‘subsections 

17 (a), (b), and (c) of section 3111’’. 

18 (4) DETERMINATION OF CONTRIBUTION

19 BASE.—Clause (iii) of section 3231(e)(2)(A) is 

20 amended to read as follows: 

21 ‘‘(iii) HOSPITAL INSURANCE AND

22 MEDICARE FOR ALL TAXES.—Clause (i) 

23 shall not apply to— 

24 ‘‘(I) so much of the rate applica25 ble under section 3201(a) or 3221(a) 
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1 as does not exceed the sum of the 

2 rates of tax in effect under sub3 sections (b) and (c) of section 3101, 

4 and 

5 ‘‘(II) so much of the rate applica6 ble under section 3211(a) as does not 

7 exceed the sum of the rates of tax in 

8 effect under subsections (b) and (c) of 

9 section 1401.’’. 

10 (e) APPLICATION OF TAX TO FEDERAL, STATE, AND

11 LOCAL EMPLOYMENT.—Paragraphs (1) and (2) of section 

12 3121(u) and section 3125(a) of such Code are each 

13 amended by striking ‘‘sections 3101(b) and 3111(b)’’ and 

14 inserting ‘‘subsections (b) and (c) of section 3101 and sub15 sections (b) and (c) of section 3111’’. 

16 (f) CONFORMING AMENDMENTS.— 

17 (1) Section 1402(a)(12)(B) of such Code is 

18 amended by striking ‘‘subsections (a) and (b) of sec19 tion 1401’’ and inserting ‘‘subsections (a), (b), and 

20 (c) of section 1401’’. 

21 (2) Section 3121(q) of such Code is amended 

22 by striking ‘‘subsections (a) and (b) of section 

23 3111’’ and inserting ‘‘subsections (a), (b), and (c) of 

24 section 3111’’. 
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1 (3) The last sentence of section 6051(a) of such 

2 Code is amended by striking ‘‘sections 3101(c) and 

3 3111(c)’’ and inserting ‘‘sections 3101(d) and 

4 3111(d)’’. 

5 (g) EFFECTIVE DATE.—The amendments made by 

6 this section shall apply to wages paid and self-employment 

7 income derived on or after January 1 of the year following 

8 the date of the enactment of this Act. 

Æ