I 

110TH CONGRESS 

1ST SESSION H. R. 2034 

To provide quality, affordable health care for all Americans. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 25, 2007 

Mr. DINGELL (for himself, Mr. RANGEL, Mr. WAXMAN, Mr. STARK, Ms. 

SCHAKOWSKY, Mr. MARKEY, Mr. WYNN, Ms. BALDWIN, Mr. TOWNS, Ms. 

SOLIS, Mr. ENGEL, Mr. GENE GREEN of Texas, and Mr. DOYLE) introduced the following bill; which was referred to the Committee on Ways 

and Means, and in addition to the Committees on Energy and Commerce 

and Oversight and Government Reform, for a period to be subsequently 

determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

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. 


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‘‘TITLE XXII—MEDICARE FOR ALL 

‘‘Sec. 2201. Quality health care for all Americans. 

‘‘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. 

‘‘Sec. 2206. Administration. 

Sec. 3. Financing through employment tax. 

Sec. 4. Collectively bargained plans. 

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. QUALITY HEALTH CARE FOR ALL AMERICANS. 

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.— 


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

2 title, the term ‘eligible individual’ means an in3 dividual who— 

4 ‘‘(i) is— 

5 ‘‘(I) a citizen of the United 

6 States; or 

7 ‘‘(II) a person who is lawfully 

8 present in the United States; and 

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

10 part A or B of title XVIII. 

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

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

13 present in the United States if such person— 

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

15 Public Law 104–193; 

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

17 title 8, Code of Federal Regulations (as in 

18 effect as of the date of enactment of the 

19 Medicare for All Act); 

20 ‘‘(iii) is eligible to apply for employ21 ment authorization from the Department 

22 of Homeland Security as listed in section 

23 274a.12 of title 8, Code of Federal Regula24 tions (as in effect as of the date of enact25 ment of the Medicare for All Act); or 


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1 ‘‘(iv) is otherwise determined to be 

2 lawfully present in the United States under 

3 criteria established by the Secretary, in 

4 consultation with the Secretary of Home5 land Security. 

6 ‘‘(3) PHASE-IN OF ELIGIBILITY.— 

7 ‘‘(A) IN GENERAL.—Subject to subpara8 graphs (B) and (C), under rules established by 

9 the Secretary, eligibility for benefits under this 

10 title shall be phased-in as follows: 

11 ‘‘(i) During the first 2 years the pro12 gram under this title is in operation, eligi13 ble individuals who are under 25 years of 

14 age or who are over 55 years of age are el15 igible for such benefits. 

16 ‘‘(ii) During the second 2 years the 

17 program under this title is in operation, el18 igible individuals who are under 35 years 

19 of age or who are over 45 years of age are 

20 eligible for such benefits. 

21 ‘‘(iii) All eligible individuals are eligi22 ble for such benefits beginning with the 

23 fifth year in which the program under this 

24 title is in operation. 


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1 ‘‘(B) NO AGING OUT OF BENEFITS DURING

2 PHASE-IN.—Once an individual is eligible for 

3 benefits under this title, the individual shall 

4 continue to be so eligible as long as the indi5 vidual is an eligible individual (as defined in 

6 paragraph (2)). 

7 ‘‘(C) ELIGIBILITY OF IMMEDIATE FAMILY

8 MEMBERS DURING PHASE-IN.—If an individual 

9 is eligible for benefits under this title, each 

10 member of such individual’s immediate family 

11 shall be eligible for such benefits if that imme12 diate family member is an eligible individual (as 

13 defined in paragraph (2)). 

14 ‘‘(b) ENROLLMENT.— 

15 ‘‘(1) IN GENERAL.—The Secretary shall estab16 lish a process under which each eligible individual is 

17 deemed to be enrolled under the program under this 

18 title. Such process shall include the following: 

19 ‘‘(A) Enrollment of family members at the 

20 same time and using a common form. 

21 ‘‘(B) Deemed enrollment of an eligible in22 dividual upon birth in the United States. 

23 ‘‘(C) Enrollment of eligible individuals at 

24 the time of immigration into the United States. 

25 ‘‘(2) ISSUANCE OF CARD.— 


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1 ‘‘(A) IN GENERAL.—The Secretary shall 

2 provide for issuance of an appropriate card for 

3 individuals entitled to benefits under the pro4 gram under this title. 

5 ‘‘(B) LINKING CARD TO AN ELECTRONIC

6 HEALTH RECORD.— 

7 ‘‘(i) IN GENERAL.—Not later than the 

8 sixth year the program under this title is 

9 in operation, the Secretary shall ensure 

10 that each such card is linked securely to an 

11 electronic health record for each such indi12 vidual. 

13 ‘‘(ii) PRIVACY PROTECTIONS.—The 

14 Secretary shall ensure that such card and 

15 such electronic health record include strong 

16 privacy protections. 

17 ‘‘(iii) AUTHORITY.—In order to ac18 complish the linkage under clause (i), the 

19 Secretary is authorized to award grants, 

20 issue contracts, alter reimbursement under 

21 the program under this title, or provide 

22 such other incentives as are reasonable and 

23 necessary. 

24 ‘‘(c) COVERAGE.— 


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

2 the Secretary shall provide for coverage of benefits 

3 for items and services furnished on and after the 

4 date an individual is entitled to benefits under the 

5 program under this title. 

6 ‘‘(2) INITIAL COVERAGE.—No coverage is avail7 able under the program under this title for items 

8 and services furnished before the date that is 18 

9 months after the date of the enactment of the Medi10 care For All Act. 

11 ‘‘(3) EXPIRATION OF COVERAGE.—An individ12 ual’s coverage under the program under this title 

13 shall terminate as of the date the individual is no 

14 longer an eligible individual. 

15 ‘‘(d) RELATION TO OTHER PROGRAMS.— 

16 ‘‘(1) CONSTRUCTION.— 

17 ‘‘(A) CONTINUED OPERATION OF PUBLIC

18 PROGRAMS.—Nothing in this title, including the 

19 application of subsection (b), shall be construed 

20 as requiring (or preventing) an individual who 

21 is entitled to benefits under the program under 

22 this title from obtaining benefits that best suit 

23 their needs under any other public health care 

24 program to which the individual is entitled, in25 cluding under a State Medicaid plan under title 


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1 XIX, the State Children’s Health Insurance 

2 Program under title XXI, a health program of 

3 the Department of Defense under chapter 55 of 

4 title 10, United States Code, a health program 

5 of the Department of Veterans Affairs under 

6 chapter 17 of title 38 of such Code, or a med7 ical care program of the Indian Health Service 

8 or of a tribal organization. 

9 ‘‘(B) CONTINUED OPERATION OF PRIVATE

10 HEALTH INSURANCE.—Nothing in this title 

11 shall be construed as preventing— 

12 ‘‘(i) an individual who is entitled to 

13 benefits under the program under this title 

14 from obtaining benefits that supplement or 

15 improve the benefits available under such 

16 program from any private health insurance 

17 plan or policy; or 

18 ‘‘(ii) one or more employers from pro19 viding or funding, pursuant to a collective 

20 bargaining agreement, such supplemental 

21 or improved benefits for individuals who 

22 are entitled to benefits under the program 

23 under this title. 

24 ‘‘(2) PRIMARY PAYOR; OTHER PUBLIC PRO25 GRAMS PROVIDING WRAP AROUND BENEFITS.—The 


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1 program under this title shall be primary payor to 

2 other public health care benefit programs and the 

3 benefits under such other public health care benefit 

4 programs shall supplement the benefits under the 

5 program under this title. 

6 ‘‘SEC. 2203. BENEFITS. 

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

8 Secretary shall provide for benefits under the program 

9 under this title consistent with the following: 

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

11 The benefits include the full range and scope of ben12 efits available under the original fee-for-service pro13 gram under parts A and B of title XVIII. 

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

15 benefits include coverage of prescription drugs at 

16 least as comprehensive as the prescription drug cov17 erage offered as of January 1, 2007, under the Blue 

18 Cross/Blue Shield Standard Plan provided under the 

19 Federal employees health benefits program under 

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

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

22 be administered in the same manner as other bene23 fits under this section. 

24 ‘‘(3) INCLUSION OF EPSDT SERVICES.—The 

25 benefits include early and periodic screening, diagVerDate Aug 31 2005 21:17 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2034.IH H2034

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1 nostic, and treatment services described in sub2 sections (a)(4)(B) and (r) of section 1905 and pro3 vided in accordance with section 1903(a)(43). 

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

5 BENEFITS.—There shall not be any treatment limi6 tations or financial requirements with respect to the 

7 coverage of benefits for mental illnesses unless com8 parable treatment limitations or financial require9 ments are imposed on medical and surgical benefits. 

10 Nothing in this paragraph shall be construed to re11 quire coverage for mental health benefits that are 

12 not medically necessary or to prohibit the appro13 priate medical management of such benefits. 

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

15 shall include coverage of such additional preventive 

16 health care items and services as the Secretary shall 

17 specify, in consultation with the United States Pre18 ventive Services Task Force. 

19 ‘‘(6) HOME AND COMMUNITY BASED SERV20 ICES.—The benefits shall include coverage of home 

21 and community-based services described in section 

22 1915(c)(4)(B). 

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

24 shall include such additional benefits that the Sec25 retary determines appropriate. 


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

2 shall be construed as preventing the Secretary from 

3 improving the benefit package from time to time to 

4 account for changes in medical practice, new infor5 mation from medical research, and other relevant 

6 developments in health science. 

7 ‘‘(9) ADJUSTMENT AUTHORIZED.—The Sec8 retary shall, on a regular basis, evaluate whether 

9 adding any of the benefits described in paragraphs 

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

11 the health of beneficiaries under the program under 

12 title XVIII. The Secretary is authorized to improve 

13 the benefits available under such program, based 

14 upon such evaluation. 

15 ‘‘(b) COST-SHARING.— 

16 ‘‘(1) IN GENERAL.—Except as otherwise pro17 vided under this subsection or subsection (a)(4), 

18 with respect to the benefits described in subsection 

19 (a)(1), such benefits shall be subject to the cost20 sharing (in the form of deductibles, coinsurance, and 

21 copayments) and premiums applicable under the 

22 program described in such subsection. 

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

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

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


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1 the form of deductibles, coinsurance, and copay2 ments) applicable under the plan described in such 

3 subsection. 

4 ‘‘(3) TREATMENT OF PREVENTIVE AND ADDI5 TIONAL SERVICES.—With respect to benefits de6 scribed in paragraphs (5) and (7) of subsection (a), 

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

8 form of deductibles, coinsurance, and copayments) 

9 that is consistent (as determined by the Secretary) 

10 with the cost-sharing applicable under paragraph 

11 (1). 

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

13 COMMUNITY-BASED SERVICES.—With respect to ben14 efits described in paragraphs (3) and (6) of sub15 section (a), such benefits shall be subject to nominal 

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

17 and copayments) that is consistent (as determined 

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

19 such services under section 1916 (as in effect on 

20 January 1, 2007). 

21 ‘‘(5) REDUCTION IN COST-SHARING FOR LOW22 INCOME INDIVIDUALS.—The Secretary shall provide 

23 for reduced cost-sharing for low-income individuals 

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1 duced cost-sharing for individuals under section 

2 1902(a)(10)(E) (as in effect on January 1, 2007). 

3 ‘‘(6) FAMILY PREMIUM.—The Secretary shall 

4 establish a premium for members of the same family 

5 with respect to benefits under the program under 

6 this title. 

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

8 HEALTH PLAN.—Except in the case of individuals who 

9 elect enrollment in a private health plan under section 

10 2204, the provisions of section 1802 shall apply under this 

11 title. 

12 ‘‘(d) PAYMENT SCHEDULE.— 

13 ‘‘(1) IN GENERAL.—The Secretary, with the as14 sistance of the Medicare Payment Advisory Commis15 sion, shall develop and implement a payment sched16 ule for benefits covered under the program under 

17 this title which are provided other than through pri18 vate health plans. To the extent feasible, such pay19 ment schedule shall be consistent with comparable 

20 payment schedules and reimbursement methodolo21 gies applied to benefits provided under parts A and 

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

23 coverage of prescription drugs, the Secretary shall 

24 provide for payment in accordance with a payment 


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1 schedule developed and implemented under the pre2 vious sentence. 

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

4 The Secretary shall establish procedures to provide 

5 reimbursement in addition to the reimbursement 

6 under paragraph (1) to health care providers that 

7 achieve measures (as established by the Secretary in 

8 consultation with health care professionals and 

9 groups representing eligible individuals) of health 

10 care quality. The Secretary shall ensure that such 

11 measures include measures of appropriate use of 

12 health information technology. 

13 ‘‘(e) APPLICATION OF BENEFICIARY PROTEC14 TIONS.—The Secretary shall provide for protections of 

15 beneficiaries under the program under this title that are 

16 not less than the beneficiary protections provided under 

17 title XVIII, including appeal rights and limitations on bal18 ance billing. 

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

20 HEALTH CARE DELIVERY SYSTEMS. 

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

22 process for— 

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

24 provision of benefits under the program under this 

25 title; and 


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

2 and change in enrollment of eligible individuals in 

3 such plans. 

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

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

6 into contracts with qualified entities for the offering 

7 of private health plans under the program under this 

8 title. In entering into such contracts the Secretary 

9 shall have the same authority that the Director of 

10 the Office of Personnel Management has with re11 spect to health benefits plans under FEHBP. 

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

13 enter into such a contract for the offering of a pri14 vate health plan under the program under this title 

15 unless at least the following requirements are met: 

16 ‘‘(A) BENEFITS AS GOOD AS YOUR CON17 GRESSMAN GETS.—Benefits under such plans 

18 are similar to or no less than the health bene19 fits coverage in any of the 4 largest health ben20 efits plans (determined by enrollment) offered 

21 under FEHBP. Such plans may provide health 

22 benefits in addition to such required benefits 

23 and may impose a premium for the provision of 

24 benefits. Such plans may not provide for finan25 cial payments or rebates to enrollees. 


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1 ‘‘(B) BENEFICIARY PROTECTIONS.—En2 rollees in such plans have beneficiary protec3 tions that are not less than the beneficiary pro4 tections applicable under this title to individuals 

5 not so enrolled and shall include beneficiary 

6 protections applicable under both FEHBP and 

7 part C of title XVIII. 

8 ‘‘(C) OTHER ADMINISTRATIVE REQUIRE9 MENTS.—The plans are subject to such require10 ments relating to licensure and solvency, protec11 tion against fraud and abuse, inspection, disclo12 sure, periodic auditing, and administrative oper13 ations and efficiencies as the Secretary identi14 fies, taking into account similar requirements 

15 under FEHBP and part C of title XVIII. 

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

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

18 enrollment period in which individuals may enroll, and 

19 change or terminate enrollment, in private health plans 

20 in a manner similar to that provided under FEHBP as 

21 of January 1, 2007. 

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

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

24 enrolled in a private health plan under this section 

25 for a month, the Secretary shall provide for payment 


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

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

3 under paragraph (3)). 

4 ‘‘(2) ANNUAL PER CAPITA AMOUNT.—The an5 nual per capita amount under this paragraph shall 

6 be the annual average per capita cost of providing 

7 benefits under the program under this title (includ8 ing both individuals enrolled and not enrolled under 

9 private health plan), as computed by the Secretary 

10 based on rules similar to the rules described in sec11 tion 1876(a)(4). 

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

13 under this subsection, the Secretary shall apply risk 

14 adjustment factors similar to those applied to pay15 ments to Medicare Advantage organizations under 

16 section 1853, except that the Secretary shall ensure 

17 that payments under this subsection are adjusted 

18 based on such factors to ensure that the health sta19 tus of the enrollee is reflected in such adjusted pay20 ments, including adjusting for the difference between 

21 the health status of the enrollee and individuals re22 ceiving benefits under the program under this title 

23 who are not so enrolled. Payments under this sub24 section must, in aggregate, reflect such differences. 


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

2 Each contract entered into or renewed under section 8902 

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

4 to offer a separate plan under this section on similar terms 

5 and conditions to, but with a separate risk pool from, the 

6 plan offered by the carrier under FEHBP. 

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

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

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

10 States a trust fund to be known as the ‘Medicare for All 

11 Trust Fund’ (in this section referred to as the ‘Trust 

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

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

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

15 to, such fund as provided in this part. 

16 ‘‘(b) TRANSFERS TO TRUST FUND.—There are here17 by appropriated to the Medicare for All Trust Fund, out 

18 of any moneys in the Treasury not otherwise appropriated, 

19 amounts equivalent to— 

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

21 sections 1401(c), 3101(c), and 3111(c) of the Inter22 nal Revenue Code of 1986; 

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

24 Treasury under section 3201 as are attributable to 

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


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

2 Treasury under section 3211 of such Code as are at3 tributable to the sum of the rates specified in section 

4 3101(c) and 3111(c) of such Code; and 

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

6 Treasury under section 3221 as are attributable to 

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

8 The amounts appropriated by the preceding sentence shall 

9 be transferred from time to time from the general fund 

10 in the Treasury to the Trust Fund, such amounts to be 

11 determined on the basis of estimates by the Secretary of 

12 the Treasury of the taxes, specified in the preceding sen13 tence, paid to or deposited into the Treasury, and proper 

14 adjustments shall be made in amounts subsequently trans15 ferred to the extent prior estimates were in excess of or 

16 were less than the taxes specified in such sentence. 

17 ‘‘(c) INCORPORATION OF PROVISIONS.— 

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

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

20 apply with respect to the Trust Fund and this title 

21 in the same manner as they apply with respect to 

22 the Federal Hospital Insurance Trust Fund and 

23 part A of title XVIII, respectively. 


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1 ‘‘(2) MISCELLANEOUS REFERENCES.—In apply2 ing provisions of section 1817 under paragraph 

3 (1)— 

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

5 part’ is construed to refer to this title; 

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

7 subsection (a) of such section shall be construed 

8 to refer to the taxes referred to in subsection 

9 (b) of this section; and 

10 ‘‘(C) the Board of Trustees of the Medi11 care for All Trust Fund shall be the same as 

12 the Board of Trustees of the Federal Hospital 

13 Insurance Trust Fund. 

14 ‘‘SEC. 2206. ADMINISTRATION. 

15 ‘‘Except as otherwise provided in this title— 

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

17 contracts with providers of services, other health 

18 care providers, and medicare administrative contrac19 tors, taking into account, and based to the greatest 

20 extent practicable upon, the types of contracts used 

21 under title XVIII with respect to such entities, to 

22 administer the program under this title; 

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

24 payable under the program under this title to such 

25 individuals shall be paid in a manner specified by 


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

2 greatest extent practicable upon, the manner in 

3 which they are provided under title XVIII); and 

4 ‘‘(3) provider participation agreements under 

5 title XVIII shall apply to enrollees and benefits 

6 under the program under this title in the same man7 ner as they apply to enrollees and benefits under the 

8 program under title XVIII.’’. 

9 (b) CONFORMING AMENDMENTS TO SOCIAL SECU10 RITY ACT PROVISIONS.— 

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

12 (42 U.S.C. 401(i)(1)) is amended— 

13 (A) by striking ‘‘or the Federal Supple14 mentary ’’ and inserting ‘‘the Federal Supple15 mentary’’; and 

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

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

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

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

20 the Federal Supplementary Medical Insurance Trust 

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

22 the Federal Supplementary Medical Insurance Trust 

23 Fund established by title XVIII, and the Medicare 

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


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1 (c) MAINTENANCE OF MEDICAID ELIGIBILITY AND

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

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

4 Act (42 U.S.C. 1396b(a)) the State may not reduce stand5 ards of eligibility, cost-sharing requirements, or benefits 

6 provided under its State Medicaid plan under title XIX 

7 of the Social Security Act below such standards of eligi8 bility and benefits in effect on the date of the enactment 

9 of this Act. 

10 SEC. 3. FINANCING THROUGH EMPLOYMENT TAX. 

11 (a) TAX ON EMPLOYEES.—Section 3101 of the Inter12 nal Revenue Code of 1986 is amended by redesignating 

13 subsection (c) as subsection (d) and by inserting after sub14 section (b) the following new subsection: 

15 ‘‘(c) MEDICARE FOR ALL.— 

16 ‘‘(1) IN GENERAL.—In addition to other taxes, 

17 there is hereby imposed on the income of every indi18 vidual a tax equal to 1.7 percent of the wages (as 

19 defined in section 3121(a)) received by him with re20 spect to employment (as defined in section 3121(b)) 

21 that are in excess of $25,000. The preceding sen22 tence shall not apply to wages received by an indi23 vidual with respect to employment during any period 

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1 dividual) is enrolled in the program under title XXII 

2 of the Social Security Act during such period. 

3 ‘‘(2) INFLATION ADJUSTMENT.—In the case of 

4 any taxable year beginning in a calendar year after 

5 2008, the dollar amount contained in paragraph (1) 

6 shall be increased by an amount equal to— 

7 ‘‘(A) such dollar amount, multiplied by 

8 ‘‘(B) the cost-of-living adjustment deter9 mined under section 1(f)(3) for the calendar 

10 year in which the taxable year begins, by sub11 stituting ‘calendar year 2007’ for ‘calendar year 

12 1992’ in subparagraph (B) thereof. 

13 If any increase determined under the preceding sentence 

14 is not a multiple of $50, such increase shall be rounded 

15 to the next lowest multiple of $50.’’. 

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

17 Code is amended by redesignating subsection (c) as sub18 section (d) and by inserting after subsection (b) the fol19 lowing new subsection: 

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

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

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

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

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

25 section 3121(b)). The preceding sentence shall not apply 


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1 to wages paid with respect to employment of an individual 

2 during any period unless the individual (or a family mem3 ber of the individual) is enrolled in the program under title 

4 XXII of the Social Security Act during such period.’’. 

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

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

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

8 following new subsection: 

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

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

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

12 to the applicable percent of the self-employment income 

13 for such taxable year. For purposes of the preceding sen14 tence, the applicable percent is a percent equal to the sum 

15 of the percent described in section 3101(c) (but only with 

16 respect to self-employment income that is in excess of the 

17 amount described in paragraph (1) of such section, as ad18 justed under paragraph (2) of such section) plus the per19 cent described in section 3111(c). This subsection shall 

20 not apply to self-employment income of an individual for 

21 a taxable year unless the individual (or a family member 

22 of the individual) is enrolled in the program under title 

23 XXII of the Social Security Act during such taxable 

24 year.’’. 

25 (d) RAILROAD RETIREMENT TAX.— 


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

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

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

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

5 (2) TAX ON EMPLOYEE REPRESENTATIVES.— 

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

7 ‘‘subsections (a) and (b) of section 3101 and sub8 sections (a) and (b) of section 3111’’ and inserting 

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

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

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

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

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

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

15 (4) DETERMINATION OF CONTRIBUTION

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

17 amended to read as follows: 

18 ‘‘(iii) HOSPITAL INSURANCE AND

19 MEDICARE FOR ALL TAXES.—Clause (i) 

20 shall not apply to— 

21 ‘‘(I) so much of the rate applica22 ble under section 3201(a) or 3221(a) 

23 as does not exceed the sum of the 

24 rates of tax in effect under subVerDate Aug 31 2005 21:17 Apr 26, 2007 Jkt 059200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H2034.IH H2034

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1 sections (b) and (c) of section 3101, 

2 and 

3 ‘‘(II) so much of the rate applica4 ble under section 3211(a) as does not 

5 exceed the sum of the rates of tax in 

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

7 section 1401.’’. 

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

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

10 3121(u) and section 3125(a) of such Code are each 

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

12 inserting ‘‘subsections (b) and (c) of section 3101 and sub13 sections (b) and (c) of section 3111’’. 

14 (f) CONFORMING AMENDMENTS.— 

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

16 amended by striking ‘‘subsections (a) and (b) of sec17 tion 1401’’ and inserting ‘‘subsections (a), (b), and 

18 (c) of section 1401’’. 

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

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

21 3111’’ and inserting ‘‘subsections (a), (b), and (c) of 

22 section 3111’’. 

23 (3) The last sentence of section 6051(a) of such 

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


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1 3111(c)’’ and inserting ‘‘sections 3101(d) and 

2 3111(d)’’. 

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

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

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

6 the date of the enactment of this Act. 

7 SEC. 4. COLLECTIVELY BARGAINED PLANS. 

8 (a) IN GENERAL.—Except as provided in subsection 

9 (c), nothing in this Act, or the amendments made by this 

10 Act, shall be construed as affecting obligations to provide 

11 or fund health care benefits under any group health plan 

12 established or maintained under or pursuant to one or 

13 more collective bargaining agreements between employee 

14 representatives and one or more employers in effect on the 

15 date of enactment of this Act. 

16 (b) APPLICATION.—The Medicare for All program 

17 under title XXII of the Social Security Act, as added by 

18 section 2(a), shall not apply to eligible individuals (as de19 fined in section 2202(a)(2) of such Act (as so added)) cov20 ered by a group health plan described in subsection (a) 

21 until the applicable collective bargaining agreement termi22 nates. 

23 (c) LIMITING BENEFITS TO INDIVIDUALS NOT YET

24 ELIGIBLE FOR MEDICARE FOR ALL.—A group health plan 

25 described in subsection (a) may, in accordance with an 


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1 agreement between the parties, limit coverage under the 

2 plan to individuals who are not eligible for benefits under 

3 such Medicare for All program. 

Æ 


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