II 

116TH CONGRESS 

2D SESSION S. 4490 

To impose an emergency tax on the increase in wealth of billionaires during 

the COVID–19 pandemic in order to pay for all of the out-of-pocket 

healthcare expenses of the uninsured and under-insured, including prescription drugs, for one year. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 6, 2020 

Mr. SANDERS (for himself, Mrs. GILLIBRAND, and Mr. MARKEY) introduced 

the following bill; which was read twice and referred to the Committee 

on Finance 

A BILL 

To impose an emergency tax on the increase in wealth of 

billionaires during the COVID–19 pandemic in order to 

pay for all of the out-of-pocket healthcare expenses of 

the uninsured and under-insured, including prescription 

drugs, for one year. 

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. 

4 This Act may be cited as the ‘‘Make Billionaires Pay 

5 Act’’. 


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1 TITLE I—PANDEMIC WEALTH 

2 TAX 

3 SEC. 101. IMPOSITION OF PANDEMIC WEALTH TAX. 

4 (a) IN GENERAL.—The Internal Revenue Code of 

5 1986 is amended by inserting after subtitle B the fol6 lowing new subtitle: 

7 ‘‘Subtitle B–1—Pandemic Wealth 

8 Tax 

‘‘CHAPTER 18—DETERMINATION OF WEALTH TAX

9 ‘‘CHAPTER 18—DETERMINATION OF 

10 WEALTH TAX 

‘‘Sec. 2901. Imposition of tax. 

‘‘Sec. 2902. Net value of assets. 

‘‘Sec. 2903. Special rules. 

11 ‘‘SECTION 2901. IMPOSITION OF TAX. 

12 ‘‘(a) IN GENERAL.—In the case of any applicable in13 dividual, there is hereby imposed a tax of 60 percent of 

14 the excess (if any) of— 

15 ‘‘(1) the net value of assets of the applicable in16 dividual on December 31, 2020, over 

17 ‘‘(2) the greater of— 

18 ‘‘(A) the net value of assets of the applica19 ble individual on March 18, 2020, or 

20 ‘‘(B) $1,000,000,000. 

21 ‘‘(b) APPLICABLE INDIVIDUAL.—For purposes of this 

22 chapter, the term ‘applicable individual’ means any indiVerDate Sep 11 2014 04:24 Sep 02, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4490.IS S4490

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1 vidual whose assets have a net value on December 31, 

2 2020, of more than $1,000,000,000. 

3 ‘‘SEC. 2902. NET VALUE OF ASSETS. 

4 ‘‘(a) IN GENERAL.—The net value of assets held by 

5 an applicable individual as of any day shall be the excess 

6 of— 

7 ‘‘(1) the value of all property of the applicable 

8 individual, real or personal, tangible or intangible, 

9 wherever situated, on such day, over 

10 ‘‘(2) the amount of any debt owed by the appli11 cable individual on such day. 

12 ‘‘(b) INCLUSION OF CERTAIN GIFTS.—For purposes 

13 of this subtitle, any property transferred by an applicable 

14 individual during the period described in section 2901(a) 

15 to an individual who is a member of the family of the ap16 plicable individual (as determined under section 267(c)(4)) 

17 and has not attained the age of 18 shall be treated as 

18 property held by the taxpayer for any date before such 

19 individual attains the age of 18. 

20 ‘‘(c) ESTABLISHMENT OF VALUATION RULES.— 

21 ‘‘(1) AUTHORITY OF SECRETARY.—The Sec22 retary shall establish rules and methods for deter23 mining the value of any asset for purposes of this 

24 subtitle. 


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1 ‘‘(2) GENERAL RULES.—Except as otherwise 

2 provided in this paragraph, the rules and methods 

3 established under paragraph (1) may be similar to 

4 the rules of part III of subchapter A of chapter 11 

5 (other than the rules of sections 2031(c), 2032A, 

6 2035, and 2044). 

7 ‘‘SEC. 2903. SPECIAL RULES. 

8 ‘‘(a) MARRIED INDIVIDUALS.—The Secretary shall 

9 by regulations establish rules for the application of this 

10 subtitle to married individuals. 

11 ‘‘(b) DECEASED INDIVIDUALS.—In the case of any 

12 individual who dies during the period described in section 

13 2901(a), section 2901(a) shall be applied by substituting 

14 the date of the individual’s death for ‘December 31, 2020’. 

15 ‘‘(c) ANTI-ABUSE RULES.—The Secretary shall pre16 scribe such rules as necessary to prevent the avoidance 

17 of the purposes of this section, including through the use 

18 of trusts.’’. 

19 (b) NO DEDUCTION FROM INCOME TAXES.—Section 

20 275 is amended by inserting after paragraph (6) the fol21 lowing new paragraph: 

22 ‘‘(7) Taxes imposed by chapter 18.’’. 

23 (c) CLERICAL AMENDMENT.—The table of subtitles 

24 is amended by inserting after the item relating to subtitle 

25 B the following new item: 

‘‘Subtitle B–1—Pandemic Wealth Tax’’. 


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1 TITLE II—REIMBURSEMENTS 

2 FOR CERTAIN COSTS OF 

3 HEALTH CARE ITEMS AND 

4 SERVICES INCLUDING PRE5 SCRIPTION DRUGS FUR6 NISHED DURING PUBLIC 

7 HEALTH EMERGENCY 

8 SEC. 201. REIMBURSEMENTS FOR CERTAIN COSTS OF 

9 HEALTH CARE ITEMS AND SERVICES INCLUD10 ING PRESCRIPTION DRUGS FURNISHED DUR11 ING PUBLIC HEALTH EMERGENCY. 

12 (a) IN GENERAL.—During the 1-year period that be13 gins on the date of enactment of this Act, the Secretary 

14 shall make payments to qualified providers with respect 

15 to applicable health care items and services as defined in 

16 subsection (b) that are furnished to an applicable indi17 vidual in an amount equal to— 

18 (1) in the case of any portion of such period in 

19 which an applicable individual is enrolled in a public 

20 or private health insurance plan, the amount of any 

21 cost-sharing, including any deductibles, copayments, 

22 coinsurance or similar charges, that would otherwise 

23 be applicable under such plan, including with respect 

24 to prescription drug coverage under the plan; and 


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1 (2) in the case of any portion of such period in 

2 which an applicable individual is uninsured, the 

3 amount that would be paid to the qualified provider 

4 for the same or equivalent items or services, includ5 ing with respect to any inpatient or physician-admin6 istered drugs (and excluding outpatient prescription 

7 drugs or biologicals with respect to which coverage 

8 is provided under subsection (e)), under the Medi9 care program under title XVIII of the Social Secu10 rity Act (42 U.S.C. 1395 et seq.). 

11 (b) APPLICABLE HEALTH CARE ITEMS AND SERV12 ICES; APPLICABLE INDIVIDUAL DEFINED.—In this sec13 tion: 

14 (1) APPLICABLE HEALTH CARE ITEMS AND

15 SERVICES.—The term ‘‘applicable health care items 

16 and services’’ means, with respect to an applicable 

17 individual, any health care items and services that 

18 are medically necessary or appropriate for the main19 tenance of health or for the diagnosis, treatment, or 

20 rehabilitation of a health condition of the applicable 

21 individual, including— 

22 (A) any testing services and treatments for 

23 COVID–19 or related complications, including 

24 vaccines, diagnostic tests, drugs and biologicals, 

25 and therapies; and 


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1 (B) in the case of an applicable individual 

2 who is enrolled in a public or private health in3 surance plan, any health care items and serv4 ices covered by such plan as of March 1, 2020, 

5 or in the case of an applicable individual who 

6 enrolls in such plan after the date, any health 

7 care items and services covered by such plan as 

8 of the date of such enrollment. 

9 (2) APPLICABLE INDIVIDUAL.—The term ‘‘ap10 plicable individual’’ means an individual who is a 

11 resident of the United States. 

12 (c) REQUIREMENTS.— 

13 (1) NO EFFECT ON APPLICABLE COST-SHARING

14 REQUIREMENTS.—Nothing in this section shall af15 fect the application of any requirements applicable 

16 under Federal or State law with respect to coverage 

17 of health care items and services without any cost 

18 sharing. 

19 (2) MAINTENANCE OF EFFORT.— 

20 (A) IN GENERAL.—During the period de21 scribed in subsection (a), a public or private 

22 health plan shall not increase cost sharing, de23 crease benefits, or otherwise make coverage less 

24 generous than the benefits offered on the date 

25 of enactment of this Act. 


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1 (B) NEW ITEMS AND SERVICES.—During 

2 such period, a public or private health plan 

3 shall provide coverage of new items and serv4 ices, including those related to COVID–19, as 

5 appropriate, at a minimum, at a level consistent 

6 with the prior coverage practices and 

7 formularies of the plan. 

8 (3) LIMITATION ON OUT-OF-POCKET EX9 PENSES.—During such period, in order to be eligible 

10 to receive payments under this section, a qualified 

11 provider shall agree not to impose on an applicable 

12 individual any charge for applicable health care 

13 items and services furnished to the applicable indi14 vidual. 

15 (4) PERMISSIBLE BILLING OF PLANS; LIMITA16 TION ON BALANCE BILLING.—During such period, in 

17 order to be eligible to receive payments under this 

18 section, a qualified provider shall agree, with respect 

19 to applicable health care items and services fur20 nished to an applicable individual when such indi21 vidual is enrolled in a public or private health insur22 ance plan— 

23 (A) not to impose any charge on the plan 

24 for such items and services beyond the amount 

25 otherwise payable by the plan; and 


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1 (B) not to bill the applicable individual for 

2 any amounts in excess of the amount described 

3 in subparagraph (A). 

4 (5) MEDICAL DEBT COLLECTION.—A qualified 

5 provider shall agree— 

6 (A) to immediately halt all medical debt 

7 collection, including collection activities carried 

8 out by third parties, during such period and 

9 shall not collect medical debt or have third par10 ties collect medical debt for applicable health 

11 care items and services furnished during such 

12 period; and 

13 (B) to refrain from pursuing medical debt 

14 collection, including collection activities carried 

15 out by third parties, after such period with re16 spect to items and services related to the diag17 nosis or treatment of COVID–19 (regardless of 

18 whether such services were furnished before, 

19 during, or after such period) and shall not col20 lect medical debt or have third parties collect 

21 medical debt for such items or services after 

22 such period. 

23 (6) SUBMISSION OF BILLS AND DOCUMENTA24 TION.—A qualified provider shall agree to submit 

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1 lating to the provision of applicable health care 

2 items and services within 30 days after the date of 

3 providing such services, in such manner as the Sec4 retary determines appropriate. 

5 (d) WAIVER OF LATE ENROLLMENT PENALTIES

6 UNDER MEDICARE.—During the period described in sub7 section (a), no increase in the monthly premium of an indi8 vidual pursuant to section 1818(c), 1839(b), or 1860D– 

9 13 of the Social Security Act (42 U.S.C. 1395i–2(c), 

10 1395r(b), 1395w–113) shall be effected in the case of any 

11 individual who enrolls for benefits under title XVIII of 

12 such Act with respect to any period prior to the date of 

13 such enrollment. 

14 (e) COVERAGE WITH RESPECT TO OUTPATIENT PRE15 SCRIPTION DRUGS.— 

16 (1) IN GENERAL.—During the period described 

17 in subsection (a), with respect to outpatient pre18 scription drugs or biologicals described in subsection 

19 (b)(1)(A) that are dispensed to uninsured individ20 uals, the Secretary shall establish procedures under 

21 which— 

22 (A) such drugs or biologicals are dispensed 

23 at no cost to such individuals; 

24 (B) pharmacies that dispense such drugs 

25 or biologicals— 


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1 (i) are reimbursed by the Secretary 

2 for such drugs or biologicals dispensed to 

3 such individuals at an amount equal to the 

4 price paid by the Secretary of Veterans Af5 fairs to procure the drug or biological 

6 under the laws administered by the Sec7 retary of Veterans Affairs; and 

8 (ii) agree not to charge such individ9 uals for any difference between the amount 

10 reimbursed under clause (i) and the cost to 

11 the pharmacy for the drug; and 

12 (C) manufacturers of such drugs or 

13 biologicals reimburse pharmacies for any dif14 ference described in subparagraph (B)(ii) with 

15 respect to drugs or biologicals of the manufac16 turer that are dispensed to such individuals. 

17 (2) CONDITION OF COVERAGE UNDER MEDI18 CARE.—During the period described in subsection 

19 (a), no coverage may be provided under part B or 

20 D of title XVIII of the Social Security Act (42 

21 U.S.C. 1395j et seq., 1395w–101 et seq.) with re22 spect to a drug or biological of a manufacturer if the 

23 manufacturer does not enter into an agreement with 

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1 ble with respect to such manufacturers under this 

2 subsection. 

3 (3) REQUIREMENT FOR PARTICIPATING PHAR4 MACIES.—During the period described in subsection 

5 (a), a prescription drug plan under part D of title 

6 XVIII of the Social Security Act (42 U.S.C. 1395w– 

7 101 et seq.) may not contract with a pharmacy if 

8 the pharmacy does not enter into an agreement with 

9 the Secretary to carry out the requirements applica10 ble with respect to pharmacies under this subsection. 

11 (f) OTHER DEFINITIONS.— 

12 (1) PUBLIC OR PRIVATE HEALTH INSURANCE

13 PLAN.— 

14 (A) IN GENERAL.—The term ‘‘public or 

15 private health insurance plan’’ means any of 

16 the following: 

17 (i) A group health plan, or group 

18 health insurance coverage, as such terms 

19 are defined in section 2791 of the Public 

20 Health Service Act (42 U.S.C. 300gg–91). 

21 (ii) A qualified health plan, as defined 

22 in section 1301 of the Patient Protection 

23 and Affordable Care Act (42 U.S.C. 

24 18021). 


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1 (iii) Subject to subparagraph (B), any 

2 health insurance coverage (other than a 

3 plan described in clause (ii)) offered in the 

4 individual market, as such terms are de5 fined in section 2791 of the Public Health 

6 Service Act, including any short-term lim7 ited duration insurance. 

8 (iv) A health plan offered under chap9 ter 89 of title 5, United States Code. 

10 (v) A Federal health care program (as 

11 defined under section 1128B(f) of the So12 cial Security Act (42 U.S.C. 1320a–7b(f)), 

13 including— 

14 (I) health benefits furnished 

15 under the TRICARE program (as de16 fined in section 1072 of title 10, 

17 United States Code); 

18 (II) health benefits furnished to 

19 veterans under the laws administered 

20 by the Secretary of Veterans Affairs; 

21 and 

22 (III) health benefits furnished to 

23 Indians (as defined in section 4 of the 

24 Indian Health Care Improvement Act 

25 (25 U.S.C. 1603)) receiving health 


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1 services through the Indian Health 

2 Service, including through an Urban 

3 Indian Organization, regardless of 

4 whether such benefits are for items or 

5 services that have been authorized 

6 under the purchased/referred care sys7 tem funded by the Indian Health 

8 Service or are covered as a health 

9 service of the Indian Health Service. 

10 (B) LIMITATION ON INDIVIDUAL HEALTH

11 INSURANCE COVERAGE.—The term ‘‘public or 

12 private health insurance coverage’’ includes the 

13 health insurance coverage described in clause 

14 (iii) of subparagraph (A) only with respect to 

15 an individual who is enrolled in such coverage 

16 on March 1, 2020. 

17 (2) QUALIFIED PROVIDER.—The term ‘‘quali18 fied provider’’ means a health care provider who is 

19 a participating provider under the Medicare program 

20 under title XVIII of the Social Security Act (42 

21 U.S.C. 1395 et seq.). Such term includes a health 

22 care provider who is not a participating provider 

23 under such program if the health care provider 

24 would meet the criteria for such participation and, 

25 if the State requires the health care provider to be 


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1 licensed by the State, is licensed by the State in 

2 which the items or services are furnished. 

3 (3) SECRETARY.—The term ‘‘Secretary’’ means 

4 the Secretary of Health and Human Services. 

5 (g) IMPLEMENTATION.— 

6 (1) IN GENERAL.—The Secretary, in coordina7 tion with the Secretary of the Treasury, the Com8 missioner of Social Security, and the Secretary of 

9 Labor, shall implement the provisions of this section 

10 not later than the date that is 7 days after the date 

11 of the enactment of this Act. 

12 (2) ENSURING TIMELY PAYMENT.—The Sec13 retary shall establish a process and issue such guid14 ance as is necessary to ensure a qualified provider 

15 receives payments under this section in a timely 

16 manner. 

17 (3) ENSURING COLLECTION OF DATA ON DIS18 PARITIES.—The Secretary shall implement this sec19 tion in a manner and issue such guidance as is nec20 essary to allow for the ongoing, accurate, and timely 

21 collection and analysis of data on disparities in ac22 cordance with subsection (h). 

23 (h) COLLECTION OF DATA ON DISPARITIES.— 

24 (1) IN GENERAL.—During the period described 

25 in subsection (a), the Secretary shall collect data on 


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1 disparities across race, ethnicity, primary language, 

2 gender, sexual orientation, disability status, age, ge3 ographic area, insurance status, and socioeconomic 

4 status— 

5 (A) in health outcomes and access to heath 

6 care related to the COVID–19 outbreak, includ7 ing data on COVID–19 cases, treatment, and 

8 deaths; and 

9 (B) in patient access to applicable health 

10 care items and services under this section. 

11 (2) PUBLIC AVAILABILITY.—The Secretary 

12 shall— 

13 (A) make data collected under this sub14 section publicly available on the internet website 

15 of the Department of Health and Human Serv16 ices as soon as is practicable, but not later than 

17 30 days after the date of enactment of this Act, 

18 in a manner that allows researchers, scholars, 

19 health care providers, and others to access and 

20 analyze such data, without compromising pa21 tient privacy; and 

22 (B) update such data on a weekly basis 

23 thereafter for the duration of the period de24 scribed in subsection (a). 

25 (i) WEEKLY REPORTS TO CONGRESS.— 


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1 (1) IN GENERAL.—On a weekly basis during 

2 the period described in subsection (a), the Secretary 

3 shall report to Congress on— 

4 (A) the implementation of this section, in5 cluding information on the amount, type, and 

6 geographic distribution of payments to qualified 

7 providers under this section; and 

8 (B) any disparities in health and access to 

9 health care related to the COVID–19 outbreak 

10 or patient access to applicable health care items 

11 and services under this section, as identified 

12 through the collection and analysis of data col13 lected under subsection (h). 

14 (2) PUBLIC AVAILABILITY.—The Secretary 

15 shall make each report submitted under paragraph 

16 (1) publicly available on the internet website of the 

17 Department of Health and Human Services. 

18 (j) FUNDING.—There are authorized to be appro19 priated $400,000,000,000 to carry out this section. 

Æ 


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