II 

110TH CONGRESS 

1ST SESSION S. 1218 

To provide quality, affordable health care for all Americans. 

IN THE SENATE OF THE UNITED STATES 

APRIL 25, 2007 

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. 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. 

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‘‘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.— 

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.— 

4 ‘‘(A) IN GENERAL.—Subject to subpara5 graphs (B) and (C), under rules established by 

6 the Secretary, eligibility for benefits under this 

7 title shall be phased-in as follows: 

8 ‘‘(i) During the first 2 years the pro9 gram under this title is in operation, eligi10 ble individuals who are under 25 years of 

11 age or who are over 55 years of age are el12 igible for such benefits. 

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

14 program under this title is in operation, el15 igible individuals who are under 35 years 

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

17 eligible for such benefits. 

18 ‘‘(iii) All eligible individuals are eligi19 ble for such benefits beginning with the 

20 fifth year in which the program under this 

21 title is in operation. 

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

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

24 benefits under this title, the individual shall 

25 continue to be so eligible as long as the indimstockstill on PROD1PC66 with BILLS

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1 vidual is an eligible individual (as defined in 

2 paragraph (2)). 

3 ‘‘(C) ELIGIBILITY OF IMMEDIATE FAMILY

4 MEMBERS DURING PHASE-IN.—If an individual 

5 is eligible for benefits under this title, each 

6 member of such individual’s immediate family 

7 shall be eligible for such benefits if that imme8 diate family member is an eligible individual (as 

9 defined in paragraph (2)). 

10 ‘‘(b) ENROLLMENT.— 

11 ‘‘(1) IN GENERAL.—The Secretary shall estab12 lish a process under which each eligible individual is 

13 deemed to be enrolled under the program under this 

14 title. Such process shall include the following: 

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

16 same time and using a common form. 

17 ‘‘(B) Deemed enrollment of an eligible in18 dividual upon birth in the United States. 

19 ‘‘(C) Enrollment of eligible individuals at 

20 the time of immigration into the United States. 

21 ‘‘(2) ISSUANCE OF CARD.— 

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

23 provide for issuance of an appropriate card for 

24 individuals entitled to benefits under the pro25 gram under this title. 

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1 ‘‘(B) LINKING CARD TO AN ELECTRONIC

2 HEALTH RECORD.— 

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

4 sixth year the program under this title is 

5 in operation, the Secretary shall ensure 

6 that each such card is linked securely to an 

7 electronic health record for each such indi8 vidual. 

9 ‘‘(ii) PRIVACY PROTECTIONS.—The 

10 Secretary shall ensure that such card and 

11 such electronic health record include strong 

12 privacy protections. 

13 ‘‘(iii) AUTHORITY.—In order to ac14 complish the linkage under clause (i), the 

15 Secretary is authorized to award grants, 

16 issue contracts, alter reimbursement under 

17 the program under this title, or provide 

18 such other incentives as are reasonable and 

19 necessary. 

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, including the 

14 application of subsection (b), shall be construed 

15 as requiring (or preventing) an individual who 

16 is entitled to benefits under the program under 

17 this title from obtaining benefits that best suit 

18 their needs under any other public health care 

19 program to which the individual is entitled, in20 cluding under a State Medicaid plan under title 

21 XIX, the State Children’s Health Insurance 

22 Program under title XXI, a health program of 

23 the Department of Defense under chapter 55 of 

24 title 10, United States Code, a health program 

25 of the Department of Veterans Affairs under 

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1 chapter 17 of title 38 of such Code, or a med2 ical care program of the Indian Health Service 

3 or of a tribal organization. 

4 ‘‘(B) CONTINUED OPERATION OF PRIVATE

5 HEALTH INSURANCE.—Nothing in this title 

6 shall be construed as preventing— 

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

8 benefits under the program under this title 

9 from obtaining benefits that supplement or 

10 improve the benefits available under such 

11 program from any private health insurance 

12 plan or policy; or 

13 ‘‘(ii) one or more employers from pro14 viding or funding, pursuant to a collective 

15 bargaining agreement, such supplemental 

16 or improved benefits for individuals who 

17 are entitled to benefits under the program 

18 under this title. 

19 ‘‘(2) PRIMARY PAYOR; OTHER PUBLIC PRO20 GRAMS PROVIDING WRAP AROUND BENEFITS.—The 

21 program under this title shall be primary payor to 

22 other public health care benefit programs and the 

23 benefits under such other public health care benefit 

24 programs shall supplement the benefits under the 

25 program under this title. 

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1 ‘‘SEC. 2203. BENEFITS. 

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

3 Secretary shall provide for benefits under the program 

4 under this title consistent with the following: 

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

6 The benefits include the full range and scope of ben7 efits available under the original fee-for-service pro8 gram under parts A and B of title XVIII. 

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

10 benefits include coverage of prescription drugs at 

11 least as comprehensive as the prescription drug cov12 erage offered as of January 1, 2007, under the Blue 

13 Cross/Blue Shield Standard Plan provided under the 

14 Federal employees health benefits program under 

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

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

17 be administered in the same manner as other bene18 fits under this section. 

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

20 benefits include early and periodic screening, diag21 nostic, and treatment services described in sub22 sections (a)(4)(B) and (r) of section 1905 and pro23 vided in accordance with section 1903(a)(43). 

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

25 BENEFITS.—There shall not be any treatment limi26 tations or financial requirements with respect to the 

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1 coverage of benefits for mental illnesses unless com2 parable treatment limitations or financial require3 ments are imposed on medical and surgical benefits. 

4 Nothing in this paragraph shall be construed to re5 quire coverage for mental health benefits that are 

6 not medically necessary or to prohibit the appro7 priate medical management of such benefits. 

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

9 shall include coverage of such additional preventive 

10 health care items and services as the Secretary shall 

11 specify, in consultation with the United States Pre12 ventive Services Task Force. 

13 ‘‘(6) HOME AND COMMUNITY BASED SERV14 ICES.—The benefits shall include coverage of home 

15 and community-based services described in section 

16 1915(c)(4)(B). 

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

18 shall include such additional benefits that the Sec19 retary determines appropriate. 

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

21 shall be construed as preventing the Secretary from 

22 improving the benefit package from time to time to 

23 account for changes in medical practice, new infor24 mation from medical research, and other relevant 

25 developments in health science. 

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1 ‘‘(9) ADJUSTMENT AUTHORIZED.—The Sec2 retary shall, on a regular basis, evaluate whether 

3 adding any of the benefits described in paragraphs 

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

5 the health of beneficiaries under the program under 

6 title XVIII. The Secretary is authorized to improve 

7 the benefits available under such program, based 

8 upon such evaluation. 

9 ‘‘(b) COST-SHARING.— 

10 ‘‘(1) IN GENERAL.—Except as otherwise pro11 vided under this subsection or subsection (a)(4), 

12 with respect to the benefits described in subsection 

13 (a)(1), such benefits shall be subject to the cost14 sharing (in the form of deductibles, coinsurance, and 

15 copayments) and premiums applicable under the 

16 program described in such subsection. 

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

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

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

20 the form of deductibles, coinsurance, and copay21 ments) applicable under the plan described in such 

22 subsection. 

23 ‘‘(3) TREATMENT OF PREVENTIVE AND ADDI24 TIONAL SERVICES.—With respect to benefits de25 scribed in paragraphs (5) and (7) of subsection (a), 

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

2 form of deductibles, coinsurance, and copayments) 

3 that is consistent (as determined by the Secretary) 

4 with the cost-sharing applicable under paragraph 

5 (1). 

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

7 COMMUNITY-BASED SERVICES.—With respect to ben8 efits described in paragraphs (3) and (6) of sub9 section (a), such benefits shall be subject to nominal 

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

11 and copayments) that is consistent (as determined 

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

13 such services under section 1916 (as in effect on 

14 January 1, 2007). 

15 ‘‘(5) REDUCTION IN COST-SHARING FOR LOW16 INCOME INDIVIDUALS.—The Secretary shall provide 

17 for reduced cost-sharing for low-income individuals 

18 in a manner that is no less protective than the re19 duced cost-sharing for individuals under section 

20 1902(a)(10)(E) (as in effect on January 1, 2007). 

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

22 establish a premium for members of the same family 

23 with respect to benefits under the program under 

24 this title. 

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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 similar to or no less than the health bene12 fits coverage in any of the 4 largest health ben13 efits plans (determined by enrollment) offered 

14 under FEHBP. Such plans may provide health 

15 benefits in addition to such required benefits 

16 and may impose a premium for the provision of 

17 benefits. Such plans may not provide for finan18 cial payments or rebates to enrollees. 

19 ‘‘(B) BENEFICIARY PROTECTIONS.—En20 rollees in such plans have beneficiary protec21 tions that are not less than the beneficiary pro22 tections applicable under this title to individuals 

23 not so enrolled and shall include beneficiary 

24 protections applicable under both FEHBP and 

25 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, 2007. 

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 

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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 separate plan under this section on similar terms 

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

23 plan offered by the carrier under 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, and based to the greatest 

11 extent practicable upon, the types of contracts used 

12 under title XVIII with respect to such entities, to 

13 administer the program under this title; 

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

15 payable under the program under this title to such 

16 individuals shall be paid in a manner specified by 

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

18 greatest extent practicable upon, the manner in 

19 which they are provided under title XVIII); and 

20 ‘‘(3) provider participation agreements under 

21 title XVIII shall apply to enrollees and benefits 

22 under the program under this title in the same man23 ner as they apply to enrollees and benefits under the 

24 program under title XVIII.’’. 

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1 (b) CONFORMING AMENDMENTS TO SOCIAL SECU2 RITY ACT PROVISIONS.— 

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

4 (42 U.S.C. 401(i)(1)) is amended— 

5 (A) by striking ‘‘or the Federal Supple6 mentary’’ and inserting ‘‘the Federal Supple7 mentary’’; and 

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

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

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

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

12 the Federal Supplementary Medical Insurance Trust 

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

14 the Federal Supplementary Medical Insurance Trust 

15 Fund established by title XVIII, and the Medicare 

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

17 (c) MAINTENANCE OF MEDICAID ELIGIBILITY AND

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

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

20 Act (42 U.S.C. 1396b(a)) the State may not reduce stand21 ards of eligibility, cost-sharing requirements, or benefits 

22 provided under its State Medicaid plan under title XIX 

23 of the Social Security Act below such standards of eligi24 bility and benefits in effect on the date of the enactment 

25 of this Act. 

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1 SEC. 3. FINANCING THROUGH EMPLOYMENT TAX. 

2 (a) TAX ON EMPLOYEES.—Section 3101 of the Inter3 nal Revenue Code of 1986 is amended by redesignating 

4 subsection (c) as subsection (d) and by inserting after sub5 section (b) the following new subsection: 

6 ‘‘(c) MEDICARE FOR ALL.— 

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

8 there is hereby imposed on the income of every indi9 vidual a tax equal to 1.7 percent of the wages (as 

10 defined in section 3121(a)) received by him with re11 spect to employment (as defined in section 3121(b)) 

12 that are in excess of $25,000. The preceding sen13 tence shall not apply to wages received by an indi14 vidual with respect to employment during any period 

15 unless the individual (or a family member of the in16 dividual) is enrolled in the program under title XXII 

17 of the Social Security Act during such period. 

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

19 any taxable year beginning in a calendar year after 

20 2008, the dollar amount contained in paragraph (1) 

21 shall be increased by an amount equal to— 

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

23 ‘‘(B) the cost-of-living adjustment deter24 mined under section 1(f)(3) for the calendar 

25 year in which the taxable year begins, by submstockstill on PROD1PC66 with BILLS

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1 stituting ‘calendar year 2007’ for ‘calendar year 

2 1992’ in subparagraph (B) thereof. 

3 If any increase determined under the preceding sentence 

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

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

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)). The preceding sentence shall not apply 

16 to wages paid with respect to employment of an individual 

17 during any period unless the individual (or a family mem18 ber of the individual) is enrolled in the program under title 

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

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

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

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

23 following new subsection: 

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

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

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

2 to the applicable percent of the self-employment income 

3 for such taxable year. For purposes of the preceding sen4 tence, the applicable percent is a percent equal to the sum 

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

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

7 amount described in paragraph (1) of such section, as ad8 justed under paragraph (2) of such section) plus the per9 cent described in section 3111(c). This subsection shall 

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

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

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

13 XXII of the Social Security Act during such taxable 

14 year.’’. 

15 (d) RAILROAD RETIREMENT TAX.— 

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

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

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

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

20 (2) TAX ON EMPLOYEE REPRESENTATIVES.— 

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

22 ‘‘subsections (a) and (b) of section 3101 and sub23 sections (a) and (b) of section 3111’’ and inserting 

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

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

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•S 1218 IS 

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

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

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

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

5 (4) DETERMINATION OF CONTRIBUTION

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

7 amended to read as follows: 

8 ‘‘(iii) HOSPITAL INSURANCE AND

9 MEDICARE FOR ALL TAXES.—Clause (i) 

10 shall not apply to— 

11 ‘‘(I) so much of the rate applica12 ble under section 3201(a) or 3221(a) 

13 as does not exceed the sum of the 

14 rates of tax in effect under sub15 sections (b) and (c) of section 3101, 

16 and 

17 ‘‘(II) so much of the rate applica18 ble under section 3211(a) as does not 

19 exceed the sum of the rates of tax in 

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

21 section 1401.’’. 

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

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

24 3121(u) and section 3125(a) of such Code are each 

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

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•S 1218 IS 

1 inserting ‘‘subsections (b) and (c) of section 3101 and sub2 sections (b) and (c) of section 3111’’. 

3 (f) CONFORMING AMENDMENTS.— 

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

5 amended by striking ‘‘subsections (a) and (b) of sec6 tion 1401’’ and inserting ‘‘subsections (a), (b), and 

7 (c) of section 1401’’. 

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

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

10 3111’’ and inserting ‘‘subsections (a), (b), and (c) of 

11 section 3111’’. 

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

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

14 3111(c)’’ and inserting ‘‘sections 3101(d) and 

15 3111(d)’’. 

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

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

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

19 the date of the enactment of this Act. 

20 SEC. 4. COLLECTIVELY BARGAINED PLANS. 

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

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

23 Act, shall be construed as affecting obligations to provide 

24 or fund health care benefits under any group health plan 

25 established or maintained under or pursuant to one or 

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•S 1218 IS 

1 more collective bargaining agreements between employee 

2 representatives and one or more employers in effect on the 

3 date of enactment of this Act. 

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

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

6 section 2(a), shall not apply to eligible individuals (as de7 fined in section 2202(a)(2) of such Act (as so added)) cov8 ered by a group health plan described in subsection (a) 

9 until the applicable collective bargaining agreement termi10 nates. 

11 (c) LIMITING BENEFITS TO INDIVIDUALS NOT YET

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

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

14 agreement between the parties, limit coverage under the 

15 plan to individuals who are not eligible for benefits under 

16 such Medicare for All program. 

Æ 

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