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. BALD-
WIN, 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 jurisdic-
tion of the committee concerned 
A BILL 
To provide quality, affordable health care for all Americans. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicare for All Act’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Medicare for all.
‘‘TITLE XXII—MEDICARE FOR ALL 
‘‘Sec. 2201. Description of program. 
‘‘Sec. 2202. Eligibility, enrollment, and coverage. 
‘‘Sec. 2203. Benefits. 
‘‘Sec. 2204. Choice of coverage under private health care delivery systems. 
‘‘Sec. 2205. Medicare for All Trust Fund. 
‘‘Sec. 2206. Administration. 
Sec. 3. Financing through employment tax. 
SEC. 2. MEDICARE FOR ALL. 
(a) ESTABLISHMENT OF PROGRAM.—The Social Se-
curity Act is amended by adding at the end the following: 
‘‘TITLE XXII—MEDICARE FOR ALL 
‘‘SEC. 2201. DESCRIPTION OF PROGRAM. 
‘‘The program under this title— 
‘‘(1) ensures that all Americans have high qual-
ity, affordable health care; 
‘‘(2) ensures that all Americans have access to 
health care as good as their Member of Congress re-
ceives; and 
‘‘(3) reduces the cost of health care and en-
hances American economic competitiveness in the 
global marketplace. 
‘‘SEC. 2202. ELIGIBILITY, ENROLLMENT, AND COVERAGE. 
‘‘(a) ELIGIBILITY.— 
‘‘(1) IN GENERAL.—Each eligible individual is 
entitled to benefits under the program under this 
title. 
‘‘(2) ELIGIBLE INDIVIDUAL.—
‘‘(A) IN GENERAL.—For purposes of this 
title, the term ‘eligible individual’ means an in-
dividual who— 
‘‘(i) is— 
‘‘(I) a citizen of the United 
States; or 
‘‘(II) a person who is lawfully 
present in the United States; and 
‘‘(ii) is not eligible for benefits under 
part A or B of title XVIII. 
‘‘(B) LAWFULLY PRESENT.—For purposes 
of subparagraph (A)(i)(II), a person is lawfully 
present in the United States if such person— 
‘‘(i) is described in section 431 of 
Public Law 104–193; 
‘‘(ii) is described in section 103.12 of 
title 8, Code of Federal Regulations (as in 
effect as of the date of enactment of the 
Medicare for All Act); 
‘‘(iii) is eligible to apply for employ-
ment authorization from the Department 
of Homeland Security as listed in section 
274a.12 of title 8, Code of Federal Regula-
tions (as in effect as of the date of enact-
ment of the Medicare for All Act); or
‘‘(iv) is otherwise determined to be 
lawfully present in the United States under 
criteria established by the Secretary, in 
consultation with the Secretary of Home-
land Security. 
‘‘(3) PHASE-IN OF ELIGIBILITY.—Under rules 
established by the Secretary, eligibility for benefits 
under this title shall be phased-in as follows: 
‘‘(A) During the first 5 years the program 
under this title is in operation, eligible individ-
uals who are under 20 years of age or who are 
over 55 years of age are eligible for such bene-
fits. 
‘‘(B) During the second 5 years the pro-
gram under this title is in operation, eligible in-
dividuals who are under 30 years of age or who 
are over 45 years of age are eligible for such 
benefits. 
‘‘(C) All eligible individuals are eligible for 
such benefits beginning with the eleventh year 
in which the program under this title is in oper-
ation. 
‘‘(b) AUTOMATIC ENROLLMENT.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a process under which each eligible individual is
deemed to be enrolled under the program under this 
title. Such process shall include the following: 
‘‘(A) Deemed enrollment of an eligible in-
dividual upon birth in the United States. 
‘‘(B) Enrollment of eligible individuals at 
the time of immigration into the United States. 
‘‘(2) ISSUANCE OF CARD.—The Secretary shall 
provide for issuance of an appropriate card for indi-
viduals entitled to benefits under the program under 
this title. Not later than the sixth year the program 
under this title is in operation, the Secretary shall 
ensure that each such card is linked securely, and 
with strong privacy protections, to an electronic 
health record for each such individual. In order to 
accomplish such linkage, the Secretary is authorized 
to award grants, issue contracts, alter reimburse-
ment under the program under this title, or provide 
such other incentives as are reasonable and nec-
essary. 
‘‘(c) COVERAGE.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
the Secretary shall provide for coverage of benefits 
for items and services furnished on and after the 
date an individual is entitled to benefits under the 
program under this title.
‘‘(2) INITIAL COVERAGE.—No coverage is avail-
able under the program under this title for items 
and services furnished before the date that is 18 
months after the date of the enactment of the Medi-
care For All Act. 
‘‘(3) EXPIRATION OF COVERAGE.—An individ-
ual’s coverage under the program under this title 
shall terminate as of the date the individual is no 
longer an eligible individual. 
‘‘(d) RELATION TO OTHER PROGRAMS.— 
‘‘(1) CONSTRUCTION.— 
‘‘(A) CONTINUED OPERATION OF PUBLIC 
PROGRAMS.—Nothing in this title shall be con-
strued as requiring (or preventing) an indi-
vidual who is entitled to benefits under the pro-
gram under this title from obtaining benefits 
under any other public health care program to 
which the individual is entitled, including under 
a State Medicaid plan under title XIX, the 
State Children’s Health Insurance Program 
under title XXI, a health program of the De-
partment of Defense under chapter 55 of title 
10, United States Code, a health program of 
the Department of Veterans Affairs under 
chapter 17 of title 38 of such Code, or a med-
ical care program of the Indian Health Service 
or of a tribal organization. The provisions of 
section 1928 shall apply to individuals insured 
for vaccines for individuals under the age of 18. 
‘‘(B) CONTINUED OPERATION OF PRIVATE 
HEALTH
INSURANCE.—Nothing in this title 
shall be construed as preventing an individual 
who is entitled to benefits under the program 
under this title from obtaining benefits that 
supplement or improve the benefits available 
under such program from any private health in-
surance plan or policy. 
‘‘(2) PRIMARY
PAYOR; OTHER
PUBLIC
PRO-
GRAMS PROVIDING WRAP AROUND BENEFITS.—The 
program under this title shall be primary payor to 
other public health care benefit programs and the 
benefits under such other public health care benefit 
programs shall supplement the benefits under the 
program under this title. 
‘‘SEC. 2203. BENEFITS. 
‘‘(a) COMPREHENSIVE
BENEFIT
PACKAGE.—The 
Secretary shall provide for benefits under the program 
under this title consistent with the following: 
‘‘(1) MEDICARE FEE-FOR-SERVICE BENEFITS.— 
The benefits include the full range and scope of ben-
efits available under the original fee-for-service pro-
gram under parts A and B of title XVIII. 
‘‘(2) PRESCRIPTION
DRUG
COVERAGE.—The 
benefits include coverage of prescription drugs at 
least as comprehensive as the prescription drug cov-
erage offered as of January 1, 2006, under the Blue 
Cross/Blue Shield Standard Plan provided under the 
Federal employees health benefits program under 
chapter 89 of title 5, United States Code (in this 
title referred to as ‘FEHBP’). Such coverage shall 
be administered in the same manner as other bene-
fits under this section. 
‘‘(3) INCLUSION OF EPSDT.—The benefits in-
clude benefits for early and periodic screening, diag-
nostic, and treatment services (as defined in sections 
1905(r), 1902(a)(43), and 1905(a)(4)(B)). 
‘‘(4) PARITY IN COVERAGE OF MENTAL HEALTH 
BENEFITS.— 
‘‘(A) IN GENERAL.—There shall not be any 
treatment limitations or financial requirements 
with respect to the coverage of benefits for 
mental illnesses unless comparable treatment 
limitations or financial requirements are im-
posed on medical and surgical benefits. Nothing 
in this subparagraph shall be construed to re-
quire coverage for mental health benefits that 
are not medically necessary or to prohibit the 
appropriate medical management of such bene-
fits. 
‘‘(B) RELATED
DEFINITIONS.—For pur-
poses of this paragraph— 
‘‘(i) 
FINANCIAL
REQUIREMENTS.— 
The term ‘financial requirements’ includes 
deductibles, 
coinsurance, 
co-payments, 
other cost-sharing, and limitations on the 
total amount that may be paid by an indi-
vidual with respect to benefits and shall in-
clude the application of annual and lifetime 
limits. 
‘‘(ii) MENTAL
HEALTH
BENEFITS.— 
The term ‘mental health benefits’ means 
benefits with respect to services for all cat-
egories of mental health conditions listed 
in the Diagnostic and Statistical Manual of 
Mental Disorders, Fourth Edition (DSM 
IV–TR), or the most recent edition if dif-
ferent than the Fourth Edition, if such 
services are included as part of an author-
ized treatment plan that is in accordance 
with standard protocols and such services
meet medical necessity criteria. Such term 
does not include benefits with respect to 
the treatment of substance abuse or chem-
ical dependency. 
‘‘(iii) 
TREATMENT
LIMITATIONS.— 
The term ‘treatment limitations’ means 
limitations on the frequency of treatment, 
number of visits or days of coverage, or 
other similar limits on the duration or 
scope of treatment under the qualifying 
health benefit plan. 
‘‘(5) PREVENTIVE
SERVICES.—The benefits 
shall include coverage of such additional preventive 
health care items and services as the Secretary shall 
specify, in consultation with the United States Pre-
ventive Services Task Force. 
‘‘(6) HOME
AND
COMMUNITY
BASED
SERV-
ICES.—The benefits shall include coverage of home 
and community-based services described in section 
1915(c)(4)(B). 
‘‘(7) ADDITIONAL
BENEFITS.—The benefits 
shall include such additional benefits that the Sec-
retary determines appropriate. 
‘‘(8) REVISION.—Nothing in this subsection 
shall be construed as preventing the Secretary from
improving the benefit package from time to time to 
account for changes in medical practice, new infor-
mation from medical research, and other relevant 
developments in health science. 
‘‘(9) ADJUSTMENT
AUTHORIZED.—The Sec-
retary shall, on a regular basis, evaluate whether 
adding any of the benefits described in paragraphs 
(1) through (7) is necessary or advisable to promote 
the health of beneficiaries under the program under 
title XVIII. The Secretary is authorized to improve 
the benefits available under such program, based 
upon such evaluation. 
‘‘(b) COST-SHARING.— 
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided under this subsection or subsection (a)(4), 
with respect to the benefits described in subsection 
(a)(1), such benefits shall be subject to the cost- 
sharing (in the form of deductibles, coinsurance, and 
copayments) and premiums applicable under the 
program described in such subsection. 
‘‘(2) PRESCRIPTION
DRUG
COVERAGE.—With 
respect to the benefits described in subsection (a)(2), 
such benefits shall be subject to the cost-sharing (in 
the form of deductibles, coinsurance, and copay-
ments) applicable under the plan described in such 
subsection. 
‘‘(3) TREATMENT OF PREVENTIVE AND ADDI-
TIONAL
SERVICES.—With respect to benefits de-
scribed in paragraphs (5) and (7) of subsection (a), 
such benefits shall be subject to cost-sharing (in the 
form of deductibles, coinsurance, and copayments) 
that is consistent (as determined by the Secretary) 
with the cost-sharing applicable under paragraph 
(1). 
‘‘(4) TREATMENT OF EPSDT AND HOME AND 
COMMUNITY-BASED SERVICES.—With respect to ben-
efits described in paragraphs (3) and (6) of sub-
section (a), such benefits shall be subject to nominal 
cost-sharing (in the form of deductibles, coinsurance, 
and copayments) that is consistent (as determined 
by the Secretary) with the cost-sharing applicable to 
such services under section 1916 (as in effect on 
January 1, 2006). 
‘‘(5) REDUCTION IN COST-SHARING FOR LOW- 
INCOME INDIVIDUALS.—The Secretary shall provide 
for reduced cost-sharing for low-income individuals 
in a manner that is no less protective than the re-
duced cost-sharing for individuals under section 
1902(a)(10)(E) (as in effect on January 1, 2006).
‘‘(c) FREEDOM TO CHOOSE YOUR OWN DOCTOR AND 
HEALTH PLAN.—Except in the case of individuals who 
elect enrollment in a private health plan under section 
2204, the provisions of section 1802 shall apply under this 
title. 
‘‘(d) PAYMENT SCHEDULE.— 
‘‘(1) IN GENERAL.—The Secretary, with the as-
sistance of the Medicare Payment Advisory Commis-
sion, shall develop and implement a payment sched-
ule for benefits covered under the program under 
this title which are provided other than through pri-
vate health plans. To the extent feasible, such pay-
ment schedule shall be consistent with comparable 
payment schedules and reimbursement methodolo-
gies applied to benefits provided under parts A and 
B of title XVIII, except, that with respect to the 
coverage of prescription drugs, the Secretary shall 
provide for payment in accordance with a payment 
schedule developed and implemented under the pre-
vious sentence. 
‘‘(2) ADDITIONAL PAYMENTS FOR QUALITY.— 
The Secretary shall establish procedures to provide 
reimbursement in addition to the reimbursement 
under paragraph (1) to health care providers that 
achieve measures (as established by the Secretary in
consultation with health care professionals and 
groups representing eligible individuals) of health 
care quality. The Secretary shall ensure that such 
measures include measures of appropriate use of 
health information technology. 
‘‘(e) 
APPLICATION
OF
BENEFICIARY
PROTEC-
TIONS.—The Secretary shall provide for protections of 
beneficiaries under the program under this title that are 
not less than the beneficiary protections provided under 
title XVIII, including appeal rights and limitations on bal-
ance billing. 
‘‘SEC. 
2204. 
CHOICE 
OF 
COVERAGE 
UNDER 
PRIVATE 
HEALTH CARE DELIVERY SYSTEMS. 
‘‘(a) IN GENERAL.—The Secretary shall provide a 
process for— 
‘‘(1) the offering of private health plans for the 
provision of benefits under the program under this 
title; and 
‘‘(2) the enrollment, disenrollment, termination, 
and change in enrollment of eligible individuals in 
such plans. 
‘‘(b) OFFERING OF PRIVATE HEALTH PLANS.— 
‘‘(1) IN GENERAL.—The Secretary shall enter 
into contracts with qualified entities for the offering 
of private health plans under the program under this
title. In entering into such contracts the Secretary 
shall have the same authority that the Director of 
the Office of Personnel Management has with re-
spect to health benefits plans under FEHBP. 
‘‘(2) REQUIREMENTS.—The Secretary shall not 
enter into such a contract for the offering of a pri-
vate health plan under the program under this title 
unless at least the following requirements are met: 
‘‘(A) BENEFITS AS GOOD AS YOUR CON-
GRESSMAN GETS.—Benefits under such plans 
are not less than the benefits offered to Mem-
bers of Congress and Federal employees under 
FEHBP. Such plans may provide health bene-
fits in addition to such required benefits and 
may impose a premium for the provision of ben-
efits. Such plans may not provide for financial 
payments or rebates to enrollees. 
‘‘(B) BENEFICIARY
PROTECTIONS.—En-
rollees in such plans have beneficiary protec-
tions that are not less than the beneficiary pro-
tections applicable under this title to individuals 
not so enrolled and shall include beneficiary 
protections applicable under both FEHBP and 
part C of title XVIII.
‘‘(C) OTHER
ADMINISTRATIVE
REQUIRE-
MENTS.—The plans are subject to such require-
ments relating to licensure and solvency, protec-
tion against fraud and abuse, inspection, disclo-
sure, periodic auditing, and administrative oper-
ations and efficiencies as the Secretary identi-
fies, taking into account similar requirements 
under FEHBP and part C of title XVIII. 
‘‘(c) ANNUAL OPEN ENROLLMENT.—The process 
under subsection (a)(2) shall provide for an annual open 
enrollment period in which individuals may enroll, and 
change or terminate enrollment, in private health plans 
in a manner similar to that provided under FEHBP as 
of January 1, 2006. 
‘‘(d) PAYMENT TO PRIVATE HEALTH PLANS.— 
‘‘(1) IN GENERAL.—In the case of an individual 
enrolled in a private health plan under this section 
for a month, the Secretary shall provide for payment 
of an amount equal to 1⁄12 of the annual per capita 
amount (described in paragraph (2), as adjusted 
under paragraph (3)). 
‘‘(2) ANNUAL PER CAPITA AMOUNT.—The an-
nual per capita amount under this paragraph shall 
be the annual average per capita cost of providing 
benefits under the program under this title (includ-
ing both individuals enrolled and not enrolled under 
private health plan), as computed by the Secretary 
based on rules similar to the rules described in sec-
tion 1876(a)(4). 
‘‘(3) RISK-ADJUSTMENT.—In making payment 
under this subsection, the Secretary shall apply risk 
adjustment factors similar to those applied to pay-
ments to Medicare Advantage organizations under 
section 1853, except that the Secretary shall ensure 
that payments under this subsection are adjusted 
based on such factors to ensure that the health sta-
tus of the enrollee is reflected in such adjusted pay-
ments, including adjusting for the difference between 
the health status of the enrollee and individuals re-
ceiving benefits under the program under this title 
who are not so enrolled. Payments under this sub-
section must, in aggregate, reflect such differences. 
‘‘(e) REQUIREMENTS
FOR FEHBP CARRIERS.— 
Each contract entered into or renewed under section 8902 
of title 5, United States Code, shall require the carrier 
to offer a plan under this section on similar terms and 
conditions to the plan offered by the carrier under 
FEHBP.
‘‘SEC. 2205. MEDICARE FOR ALL TRUST FUND. 
‘‘(a) ESTABLISHMENT OF TRUST FUND.—There is 
hereby created on the books of the Treasury of the United 
States a trust fund to be known as the ‘Medicare for All 
Trust Fund’ (in this section referred to as the ‘Trust 
Fund’). The Trust Fund shall consist of such gifts and 
bequests as may be made as provided in section 201(i)(1), 
and such amounts as may be deposited in, or appropriated 
to, such fund as provided in this part. 
‘‘(b) TRANSFERS TO TRUST FUND.—There are here-
by appropriated to the Medicare for All Trust Fund, out 
of any moneys in the Treasury not otherwise appropriated, 
amounts equivalent to— 
‘‘(1) the taxes received in the Treasury under 
sections 1401(c), 3101(c), and 3111(c) of the Inter-
nal Revenue Code of 1986; 
‘‘(2) such portion of the taxes received in the 
Treasury under section 3201 as are attributable to 
the rate specified in section 3101(c) of such Code; 
‘‘(3) such portion of the taxes received in the 
Treasury under section 3211 of such Code as are at-
tributable to the sum of the rates specified in section 
3101(c) and 3111(c) of such Code; and 
‘‘(4) such portion of the taxes received in the 
Treasury under section 3221 as are attributable to 
the rate specified in section 3111(c) of such Code.
The amounts appropriated by the preceding sentence shall 
be transferred from time to time from the general fund 
in the Treasury to the Trust Fund, such amounts to be 
determined on the basis of estimates by the Secretary of 
the Treasury of the taxes, specified in the preceding sen-
tence, paid to or deposited into the Treasury, and proper 
adjustments shall be made in amounts subsequently trans-
ferred to the extent prior estimates were in excess of or 
were less than the taxes specified in such sentence. 
‘‘(c) INCORPORATION OF PROVISIONS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
subsections (b) through (i) of section 1817 shall 
apply with respect to the Trust Fund and this title 
in the same manner as they apply with respect to 
the Federal Hospital Insurance Trust Fund and 
part A of title XVIII, respectively. 
‘‘(2) MISCELLANEOUS REFERENCES.—In apply-
ing provisions of section 1817 under paragraph 
(1)— 
‘‘(A) any reference in such section to ‘this 
part’ is construed to refer to this title; 
‘‘(B) any reference to taxes referred to in 
subsection (a) of such section shall be construed 
to refer to the taxes referred to in subsection 
(b) of this section; and
‘‘(C) the Board of Trustees of the Medi-
care for All Trust Fund shall be the same as 
the Board of Trustees of the Federal Hospital 
Insurance Trust Fund. 
‘‘SEC. 2206. ADMINISTRATION. 
‘‘Except as otherwise provided in this title— 
‘‘(1) the Secretary shall enter into appropriate 
contracts with providers of services, other health 
care providers, and medicare administrative contrac-
tors, taking into account the types of contracts used 
under title XVIII with respect to such entities, to 
administer the program under this title; 
‘‘(2) benefits described in section 2203 that are 
payable under the program under this title to such 
individuals shall be paid in a manner specified by 
the Secretary (taking into account, and based to the 
greatest extent practicable upon, the manner in 
which they are provided under title XVIII); and 
‘‘(3) provider participation agreements under 
title XVIII shall apply to enrollees and benefits 
under the program under this title in the same man-
ner as they apply to enrollees and benefits under the 
program under title XVIII.’’. 
(b) CONFORMING AMENDMENTS TO SOCIAL SECU-
RITY ACT PROVISIONS.—