I 

109TH CONGRESS 

2D SESSION H. R. 4683 

To provide quality, affordable health care for all Americans. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 1, 2006 

Mr. DINGELL (for himself, Mr. STARK, Mr. BROWN of Ohio, Mr. WAXMAN, 

Mr. RANGEL, Mr. WYNN, Mr. STRICKLAND, Mr. BOUCHER, Ms. BALDWIN, Ms. SCHAKOWSKY, Mr. RUSH, Mr. TOWNS, Mr. ROSS, Mr. MARKEY, 

Mr. GENE GREEN of Texas, and Mr. ALLEN) 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 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. 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. 

‘‘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.— 
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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.—Under rules 

7 established by the Secretary, eligibility for benefits 

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

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

10 under this title is in operation, eligible individ11 uals who are under 20 years of age or who are 

12 over 55 years of age are eligible for such bene13 fits. 

14 ‘‘(B) During the second 5 years the pro15 gram under this title is in operation, eligible in16 dividuals who are under 30 years of age or who 

17 are over 45 years of age are eligible for such 

18 benefits. 

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

20 such benefits beginning with the eleventh year 

21 in which the program under this title is in oper22 ation. 

23 ‘‘(b) AUTOMATIC ENROLLMENT.— 

24 ‘‘(1) IN GENERAL.—The Secretary shall estab25 lish a process under which each eligible individual is 
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1 deemed to be enrolled under the program under this 

2 title. Such process shall include the following: 

3 ‘‘(A) Deemed enrollment of an eligible in4 dividual upon birth in the United States. 

5 ‘‘(B) Enrollment of eligible individuals at 

6 the time of immigration into the United States. 

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

8 provide for issuance of an appropriate card for indi9 viduals entitled to benefits under the program under 

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

11 under this title is in operation, the Secretary shall 

12 ensure that each such card is linked securely, and 

13 with strong privacy protections, to an electronic 

14 health record for each such individual. In order to 

15 accomplish such linkage, the Secretary is authorized 

16 to award grants, issue contracts, alter reimburse17 ment under the program under this title, or provide 

18 such other incentives as are reasonable and nec19 essary. 

20 ‘‘(c) COVERAGE.— 

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

22 the Secretary shall provide for coverage of benefits 

23 for items and services furnished on and after the 

24 date an individual is entitled to benefits under the 

25 program under this title. 
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1 ‘‘(2) INITIAL COVERAGE.—No coverage is avail2 able under the program under this title for items 

3 and services furnished before the date that is 18 

4 months after the date of the enactment of the Medi5 care For All Act. 

6 ‘‘(3) EXPIRATION OF COVERAGE.—An individ7 ual’s coverage under the program under this title 

8 shall terminate as of the date the individual is no 

9 longer an eligible individual. 

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

11 ‘‘(1) CONSTRUCTION.— 

12 ‘‘(A) CONTINUED OPERATION OF PUBLIC

13 PROGRAMS.—Nothing in this title shall be con14 strued as requiring (or preventing) an indi15 vidual who is entitled to benefits under the pro16 gram under this title from obtaining benefits 

17 under any other public health care program to 

18 which the individual is entitled, including under 

19 a State Medicaid plan under title XIX, the 

20 State Children’s Health Insurance Program 

21 under title XXI, a health program of the De22 partment of Defense under chapter 55 of title 

23 10, United States Code, a health program of 

24 the Department of Veterans Affairs under 

25 chapter 17 of title 38 of such Code, or a med-
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1 ical care program of the Indian Health Service 

2 or of a tribal organization. The provisions of 

3 section 1928 shall apply to individuals insured 

4 for vaccines for individuals under the age of 18. 

5 ‘‘(B) CONTINUED OPERATION OF PRIVATE

6 HEALTH INSURANCE.—Nothing in this title 

7 shall be construed as preventing an individual 

8 who is entitled to benefits under the program 

9 under this title from obtaining benefits that 

10 supplement or improve the benefits available 

11 under such program from any private health in12 surance plan or policy. 

13 ‘‘(2) PRIMARY PAYOR; OTHER PUBLIC PRO14 GRAMS PROVIDING WRAP AROUND BENEFITS.—The 

15 program under this title shall be primary payor to 

16 other public health care benefit programs and the 

17 benefits under such other public health care benefit 

18 programs shall supplement the benefits under the 

19 program under this title. 

20 ‘‘SEC. 2203. BENEFITS. 

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

22 Secretary shall provide for benefits under the program 

23 under this title consistent with the following: 

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

25 The benefits include the full range and scope of ben-
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1 efits available under the original fee-for-service pro2 gram under parts A and B of title XVIII. 

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

4 benefits include coverage of prescription drugs at 

5 least as comprehensive as the prescription drug cov6 erage offered as of January 1, 2006, under the Blue 

7 Cross/Blue Shield Standard Plan provided under the 

8 Federal employees health benefits program under 

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

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

11 be administered in the same manner as other bene12 fits under this section. 

13 ‘‘(3) INCLUSION OF EPSDT.—The benefits in14 clude benefits for early and periodic screening, diag15 nostic, and treatment services (as defined in sections 

16 1905(r), 1902(a)(43), and 1905(a)(4)(B)). 

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

18 BENEFITS.— 

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

20 treatment limitations or financial requirements 

21 with respect to the coverage of benefits for 

22 mental illnesses unless comparable treatment 

23 limitations or financial requirements are im24 posed on medical and surgical benefits. Nothing 

25 in this subparagraph shall be construed to re-
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1 quire coverage for mental health benefits that 

2 are not medically necessary or to prohibit the 

3 appropriate medical management of such bene4 fits. 

5 ‘‘(B) RELATED DEFINITIONS.—For pur6 poses of this paragraph— 

7 ‘‘(i) FINANCIAL REQUIREMENTS.— 

8 The term ‘financial requirements’ includes 

9 deductibles, coinsurance, co-payments, 

10 other cost-sharing, and limitations on the 

11 total amount that may be paid by an indi12 vidual with respect to benefits and shall in13 clude the application of annual and lifetime 

14 limits. 

15 ‘‘(ii) MENTAL HEALTH BENEFITS.— 

16 The term ‘mental health benefits’ means 

17 benefits with respect to services for all cat18 egories of mental health conditions listed 

19 in the Diagnostic and Statistical Manual of 

20 Mental Disorders, Fourth Edition (DSM 

21 IV–TR), or the most recent edition if dif22 ferent than the Fourth Edition, if such 

23 services are included as part of an author24 ized treatment plan that is in accordance 

25 with standard protocols and such services 
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1 meet medical necessity criteria. Such term 

2 does not include benefits with respect to 

3 the treatment of substance abuse or chem4 ical dependency. 

5 ‘‘(iii) TREATMENT LIMITATIONS.— 

6 The term ‘treatment limitations’ means 

7 limitations on the frequency of treatment, 

8 number of visits or days of coverage, or 

9 other similar limits on the duration or 

10 scope of treatment under the qualifying 

11 health benefit plan. 

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

13 shall include coverage of such additional preventive 

14 health care items and services as the Secretary shall 

15 specify, in consultation with the United States Pre16 ventive Services Task Force. 

17 ‘‘(6) HOME AND COMMUNITY BASED SERV18 ICES.—The benefits shall include coverage of home 

19 and community-based services described in section 

20 1915(c)(4)(B). 

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

22 shall include such additional benefits that the Sec23 retary determines appropriate. 

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

25 shall be construed as preventing the Secretary from 
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1 improving the benefit package from time to time to 

2 account for changes in medical practice, new infor3 mation from medical research, and other relevant 

4 developments in health science. 

5 ‘‘(9) ADJUSTMENT AUTHORIZED.—The Sec6 retary shall, on a regular basis, evaluate whether 

7 adding any of the benefits described in paragraphs 

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

9 the health of beneficiaries under the program under 

10 title XVIII. The Secretary is authorized to improve 

11 the benefits available under such program, based 

12 upon such evaluation. 

13 ‘‘(b) COST-SHARING.— 

14 ‘‘(1) IN GENERAL.—Except as otherwise pro15 vided under this subsection or subsection (a)(4), 

16 with respect to the benefits described in subsection 

17 (a)(1), such benefits shall be subject to the cost18 sharing (in the form of deductibles, coinsurance, and 

19 copayments) and premiums applicable under the 

20 program described in such subsection. 

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

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

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

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

2 subsection. 

3 ‘‘(3) TREATMENT OF PREVENTIVE AND ADDI4 TIONAL SERVICES.—With respect to benefits de5 scribed in paragraphs (5) and (7) of subsection (a), 

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

7 form of deductibles, coinsurance, and copayments) 

8 that is consistent (as determined by the Secretary) 

9 with the cost-sharing applicable under paragraph 

10 (1). 

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

12 COMMUNITY-BASED SERVICES.—With respect to ben13 efits described in paragraphs (3) and (6) of sub14 section (a), such benefits shall be subject to nominal 

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

16 and copayments) that is consistent (as determined 

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

18 such services under section 1916 (as in effect on 

19 January 1, 2006). 

20 ‘‘(5) REDUCTION IN COST-SHARING FOR LOW21 INCOME INDIVIDUALS.—The Secretary shall provide 

22 for reduced cost-sharing for low-income individuals 

23 in a manner that is no less protective than the re24 duced cost-sharing for individuals under section 

25 1902(a)(10)(E) (as in effect on January 1, 2006). 
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1 ‘‘(c) FREEDOM TO CHOOSE YOUR OWN DOCTOR AND

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

3 elect enrollment in a private health plan under section 

4 2204, the provisions of section 1802 shall apply under this 

5 title. 

6 ‘‘(d) PAYMENT SCHEDULE.— 

7 ‘‘(1) IN GENERAL.—The Secretary, with the as8 sistance of the Medicare Payment Advisory Commis9 sion, shall develop and implement a payment sched10 ule for benefits covered under the program under 

11 this title which are provided other than through pri12 vate health plans. To the extent feasible, such pay13 ment schedule shall be consistent with comparable 

14 payment schedules and reimbursement methodolo15 gies applied to benefits provided under parts A and 

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

17 coverage of prescription drugs, the Secretary shall 

18 provide for payment in accordance with a payment 

19 schedule developed and implemented under the pre20 vious sentence. 

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

22 The Secretary shall establish procedures to provide 

23 reimbursement in addition to the reimbursement 

24 under paragraph (1) to health care providers that 

25 achieve measures (as established by the Secretary in 
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1 consultation with health care professionals and 

2 groups representing eligible individuals) of health 

3 care quality. The Secretary shall ensure that such 

4 measures include measures of appropriate use of 

5 health information technology. 

6 ‘‘(e) APPLICATION OF BENEFICIARY PROTEC7 TIONS.—The Secretary shall provide for protections of 

8 beneficiaries under the program under this title that are 

9 not less than the beneficiary protections provided under 

10 title XVIII, including appeal rights and limitations on bal11 ance billing. 

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

13 HEALTH CARE DELIVERY SYSTEMS. 

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

15 process for— 

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

17 provision of benefits under the program under this 

18 title; and 

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

20 and change in enrollment of eligible individuals in 

21 such plans. 

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

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

24 into contracts with qualified entities for the offering 

25 of private health plans under the program under this 
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1 title. In entering into such contracts the Secretary 

2 shall have the same authority that the Director of 

3 the Office of Personnel Management has with re4 spect to health benefits plans under FEHBP. 

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

6 enter into such a contract for the offering of a pri7 vate health plan under the program under this title 

8 unless at least the following requirements are met: 

9 ‘‘(A) BENEFITS AS GOOD AS YOUR CON10 GRESSMAN GETS.—Benefits under such plans 

11 are not less than the benefits offered to Mem12 bers of Congress and Federal employees under 

13 FEHBP. Such plans may provide health bene14 fits in addition to such required benefits and 

15 may impose a premium for the provision of ben16 efits. Such plans may not provide for financial 

17 payments or rebates to enrollees. 

18 ‘‘(B) BENEFICIARY PROTECTIONS.—En19 rollees in such plans have beneficiary protec20 tions that are not less than the beneficiary pro21 tections applicable under this title to individuals 

22 not so enrolled and shall include beneficiary 

23 protections applicable under both FEHBP and 

24 part C of title XVIII. 
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1 ‘‘(C) OTHER ADMINISTRATIVE REQUIRE2 MENTS.—The plans are subject to such require3 ments relating to licensure and solvency, protec4 tion against fraud and abuse, inspection, disclo5 sure, periodic auditing, and administrative oper6 ations and efficiencies as the Secretary identi7 fies, taking into account similar requirements 

8 under FEHBP and part C of title XVIII. 

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

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

11 enrollment period in which individuals may enroll, and 

12 change or terminate enrollment, in private health plans 

13 in a manner similar to that provided under FEHBP as 

14 of January 1, 2006. 

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

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

17 enrolled in a private health plan under this section 

18 for a month, the Secretary shall provide for payment 

of an amount equal to 1 19 ⁄12 of the annual per capita 

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

21 under paragraph (3)). 

22 ‘‘(2) ANNUAL PER CAPITA AMOUNT.—The an23 nual per capita amount under this paragraph shall 

24 be the annual average per capita cost of providing 

25 benefits under the program under this title (includ-
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1 ing both individuals enrolled and not enrolled under 

2 private health plan), as computed by the Secretary 

3 based on rules similar to the rules described in sec4 tion 1876(a)(4). 

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

6 under this subsection, the Secretary shall apply risk 

7 adjustment factors similar to those applied to pay8 ments to Medicare Advantage organizations under 

9 section 1853, except that the Secretary shall ensure 

10 that payments under this subsection are adjusted 

11 based on such factors to ensure that the health sta12 tus of the enrollee is reflected in such adjusted pay13 ments, including adjusting for the difference between 

14 the health status of the enrollee and individuals re15 ceiving benefits under the program under this title 

16 who are not so enrolled. Payments under this sub17 section must, in aggregate, reflect such differences. 

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

19 Each contract entered into or renewed under section 8902 

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

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

22 conditions to the plan offered by the carrier under 

23 FEHBP. 
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1 ‘‘SEC. 2205. MEDICARE FOR ALL TRUST FUND. 

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

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

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

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

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

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

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

9 to, such fund as provided in this part. 

10 ‘‘(b) TRANSFERS TO TRUST FUND.—There are here11 by appropriated to the Medicare for All Trust Fund, out 

12 of any moneys in the Treasury not otherwise appropriated, 

13 amounts equivalent to— 

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

15 sections 1401(c), 3101(c), and 3111(c) of the Inter16 nal Revenue Code of 1986; 

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

18 Treasury under section 3201 as are attributable to 

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

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

21 Treasury under section 3211 of such Code as are at22 tributable to the sum of the rates specified in section 

23 3101(c) and 3111(c) of such Code; and 

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

25 Treasury under section 3221 as are attributable to 

26 the rate specified in section 3111(c) of such Code. 
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1 The amounts appropriated by the preceding sentence shall 

2 be transferred from time to time from the general fund 

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

4 determined on the basis of estimates by the Secretary of 

5 the Treasury of the taxes, specified in the preceding sen6 tence, paid to or deposited into the Treasury, and proper 

7 adjustments shall be made in amounts subsequently trans8 ferred to the extent prior estimates were in excess of or 

9 were less than the taxes specified in such sentence. 

10 ‘‘(c) INCORPORATION OF PROVISIONS.— 

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

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

13 apply with respect to the Trust Fund and this title 

14 in the same manner as they apply with respect to 

15 the Federal Hospital Insurance Trust Fund and 

16 part A of title XVIII, respectively. 

17 ‘‘(2) MISCELLANEOUS REFERENCES.—In apply18 ing provisions of section 1817 under paragraph 

19 (1)— 

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

21 part’ is construed to refer to this title; 

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

23 subsection (a) of such section shall be construed 

24 to refer to the taxes referred to in subsection 

25 (b) of this section; and 
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1 ‘‘(C) the Board of Trustees of the Medi2 care for All Trust Fund shall be the same as 

3 the Board of Trustees of the Federal Hospital 

4 Insurance Trust Fund. 

5 ‘‘SEC. 2206. ADMINISTRATION. 

6 ‘‘Except as otherwise provided in this title— 

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

8 contracts with providers of services, other health 

9 care providers, and medicare administrative contrac10 tors, taking into account the types of contracts used 

11 under title XVIII with respect to such entities, to 

12 administer the program under this title; 

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

14 payable under the program under this title to such 

15 individuals shall be paid in a manner specified by 

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

17 greatest extent practicable upon, the manner in 

18 which they are provided under title XVIII); and 

19 ‘‘(3) provider participation agreements under 

20 title XVIII shall apply to enrollees and benefits 

21 under the program under this title in the same man22 ner as they apply to enrollees and benefits under the 

23 program under title XVIII.’’. 

24 (b) CONFORMING AMENDMENTS TO SOCIAL SECU25 RITY ACT PROVISIONS.— 
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1 (1) Section 201(i)(1) of the Social Security Act 

2 (42 U.S.C. 401(i)(1)) is amended— 

3 (A) by striking ‘‘or the Federal Supple4 mentary ’’ and inserting ‘‘the Federal Supple5 mentary’’; and 

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

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

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

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

10 the Federal Supplementary Medical Insurance Trust 

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

12 the Federal Supplementary Medical Insurance Trust 

13 Fund established by title XVIII, and the Medicare 

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

15 (c) MAINTENANCE OF MEDICAID ELIGIBILITY AND

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

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

18 Act (42 U.S.C. 1396b(a)) the State may not reduce stand19 ards of eligibility or benefits provided under its State Med20 icaid plan under title XIX of the Social Security Act below 

21 such standards of eligibility and benefits in effect on the 

22 date of the enactment of this Act. 

23 SEC. 3. FINANCING THROUGH EMPLOYMENT TAX. 

24 (a) TAX ON EMPLOYEES.—Section 3101 of the Inter25 nal Revenue Code of 1986 is amended by redesignating 
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1 subsection (c) as subsection (d) and by inserting after sub2 section (b) the following new subsection: 

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

4 taxes, there is hereby imposed on the income of every indi5 vidual a tax equal to 1.7 percent of the wages (as defined 

6 in section 3121(a)) received by him with respect to em7 ployment (as defined in section 3121(b)).’’. 

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

9 Code is amended by redesignating subsection (c) as sub10 section (d) and by inserting after subsection (b) the fol11 lowing new subsection: 

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

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

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

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

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

17 section 3121(b)).’’. 

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

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

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

21 following new subsection: 

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

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

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

25 to the applicable percent of the self-employment income 
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1 for such taxable year. For purposes of the preceding sen2 tence, the applicable percent is a percent equal to the sum 

3 of the percent described in section 3101(c) plus the per4 cent described in section 3111(c).’’. 

5 (d) RAILROAD RETIREMENT TAX.— 

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

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

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

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

10 (2) TAX ON EMPLOYEE REPRESENTATIVES.— 

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

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

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

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

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

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

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

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

20 (4) DETERMINATION OF CONTRIBUTION

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

22 amended to read as follows: 

23 ‘‘(iii) HOSPITAL INSURANCE AND

24 MEDICARE FOR ALL TAXES.—Clause (i) 

25 shall not apply to— 
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1 ‘‘(I) so much of the rate applica2 ble under section 3201(a) or 3221(a) 

3 as does not exceed the sum of the 

4 rates of tax in effect under sub5 sections (b) and (c) of section 3101, 

6 and 

7 ‘‘(II) so much of the rate applica8 ble under section 3211(a) as does not 

9 exceed the sum of the rates of tax in 

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

11 section 1401.’’. 

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

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

14 3121(u) and section 3125(a) of such Code are each 

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

16 inserting ‘‘subsections (b) and (c) of section 3101 and sub17 sections (b) and (c) of section 3111’’. 

18 (f) CONFORMING AMENDMENTS.— 

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

20 amended by striking ‘‘subsections (a) and (b) of sec21 tion 1401’’ and inserting ‘‘subsections (a), (b), and 

22 (c) of section 1401’’. 

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

24 by striking ‘‘subsections (a) and (b) of section 
25 

•HR 4683 IH 

1 3111’’ and inserting ‘‘subsections (a), (b), and (c) of 

2 section 3111’’. 

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

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

5 3111(c)’’ and inserting ‘‘sections 3101(d) and 

6 3111(d)’’. 

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

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

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

10 the date of the enactment of this Act. 

Æ