I 
108TH CONGRESS 
2D SESSION 
H. R. 3702
To amend title XVIII of the Social Security Act, as amended by the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003, to 
provide additional beneficiary protections. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 20, 2004
Mr. CARDIN introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, 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 amend title XVIII of the Social Security Act, as amended 
by the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003, to provide additional bene-
ficiary protections.
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 
‘‘Preserving Medicare for All Act of 2004’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows:
Sec. 1. Short title; table of contents. 
Sec. 2. Authority to negotiate prices. 
Sec. 3. Guaranteed prescription drug benefits. 
Sec. 4. Full reimbursement for qualified retiree prescription drug plans. 
Sec. 5. Repeal of Comparative Cost Adjustment (CCA) program. 
Sec. 6. Repeal of MA Regional Plan Stabilization Fund. 
Sec. 7. Repeal of cost containment provisions.
SEC. 2. AUTHORITY TO NEGOTIATE PRICES. 
Subsection (i) of section 1860D–11, as added by sec-
tion 101 of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (Public Law 108–173), 
is repealed. 
SEC. 3. GUARANTEED PRESCRIPTION DRUG BENEFITS. 
(a) IN GENERAL.—Section 1860D–3 of the Social 
Security Act, as added by section 101 of the Medicare Pre-
scription Drug, Improvement, and Modernization Act of 
2003 (Public Law 108–173), is amended to read as fol-
lows: 
‘‘ACCESS TO A CHOICE OF QUALIFIED PRESCRIPTION 
DRUG COVERAGE 
‘‘SEC. 1860D–3. (a) ASSURING ACCESS TO A CHOICE 
OF COVERAGE.—
‘‘(1) CHOICE OF AT LEAST THREE PLANS IN 
EACH AREA.—The Secretary shall ensure that each 
part D eligible individual has available, consistent 
with paragraph (2), a choice of enrollment in—
‘‘(A) a nationwide prescription drug plan 
offered by the Secretary in accordance with 
subsection (b); and
‘‘(B) at least 2 qualifying plans (as defined 
in paragraph (3)) in the area in which the indi-
vidual resides, at least one of which is a pre-
scription drug plan. 
‘‘(2) REQUIREMENT
FOR
DIFFERENT
PLAN 
SPONSORS.—The requirement in paragraph (1)(B) is 
not satisfied with respect to an area if only one enti-
ty offers all the qualifying plans in the area. 
‘‘(3) QUALIFYING
PLAN
DEFINED.—For pur-
poses of this section, the term ‘qualifying plan’ 
means—
‘‘(A) a prescription drug plan; 
‘‘(B) an MA–PD plan described in section 
1851(a)(2)(A)(i) that provides—
‘‘(i) basic prescription drug coverage; 
or 
‘‘(ii) qualified prescription drug cov-
erage that provides supplemental prescrip-
tion drug coverage so long as there is no 
MA monthly supplemental beneficiary pre-
mium applied under the plan, due to the 
application of a credit against such pre-
mium 
of 
a 
rebate 
under 
section 
1854(b)(1)(C); or
‘‘(C) a nationwide prescription drug plan 
offered by the Secretary in accordance with 
subsection (b). 
‘‘(b) HHS AS PDP SPONSOR FOR A NATIONWIDE 
PRESCRIPTION DRUG PLAN.—
‘‘(1) IN GENERAL.—The Secretary, through the 
Administrator of the Centers for Medicare & Med-
icaid Services, shall take such steps as may be nec-
essary to qualify and serve as a PDP sponsor and 
to offer a prescription drug plan that offers basic 
prescription drug coverage throughout the United 
States. Such a plan shall be in addition to, and not 
in lieu of, other prescription drug plans offered 
under this part. 
‘‘(2) PREMIUM; SOLVENCY; AUTHORITIES.—In 
carrying out paragraph (1), the Secretary—
‘‘(A) shall establish a premium in the 
amount of $35 for months in 2006 and, for 
months in subsequent years, in the amount 
specified in this paragraph for months in the 
previous year increased by the annual percent-
age increase described in section 1860D–
2(b)(6) (relating to growth in medicare pre-
scription drug costs per beneficiary) for the 
year involved;
‘‘(B) is deemed to have met any applicable 
solvency and capital adequacy standards; and 
‘‘(C) shall exercise such authorities (includ-
ing the use of regional or other pharmaceutical 
benefit managers) as the Secretary determines 
necessary to offer the prescription drug plan in 
the same or a comparable manner as is the case 
for prescription drug plans offered by private 
PDP sponsors. 
‘‘(c) FLEXIBILITY IN RISK ASSUMED.—In order to 
ensure access pursuant to subsection (a) in an area the 
Secretary may approve limited risk plans under section 
1860D–11(f) for the area.’’. 
(b) CONFORMING AMENDMENT.—Section 1860D–11 
of the Social Security Act, as added by section 101 of the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173), is amended 
by striking subsection (g). 
SEC. 4. FULL REIMBURSEMENT FOR QUALIFIED RETIREE 
PRESCRIPTION DRUG PLANS. 
(a) ELIMINATION OF TRUE OUT-OF-POCKET LIMI-
TATION.—Section 1860D–2(b)(4)(C)(ii) of the Social Se-
curity Act, as added by section 101(a) of the Medicare 
Prescription Drug, Improvement, and Modernization Act 
of 2003 (Public Law 108–173), is amended—
(1) by inserting ‘‘under a qualified retiree pre-
scription drug plan (as defined in section 1860D–
22(a)(2)),’’ after ‘‘under section 1860D–14,’’; and 
(2) by inserting ‘‘, under such a qualified re-
tiree prescription drug plan,’’ after ‘‘(other than 
under such section’’ . 
(b) EQUALIZATION OF SUBSIDIES.—Notwithstanding 
any other provision of law, the Secretary of Health and 
Human Services shall provide for such increase in the spe-
cial subsidy payment amounts under section 1860D–
22(a)(3) of the Social Security Act, as added by section 
101(a) of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (Public Law 108–173), 
as may be appropriate to provide for payments in the ag-
gregate equivalent to the payments that would have been 
made under section 1860D–15 of such Act if the individ-
uals were not enrolled in a qualified retiree prescription 
drug plan. In making such computation, the Secretary 
shall not take into account the application of the amend-
ments made by section 1202 of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003. 
SEC. 5. REPEAL OF COMPARATIVE COST ADJUSTMENT 
(CCA) PROGRAM. 
Subtitle E of title II of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Pub-
lic Law 108–173), and the amendments made by such 
subtitle, are repealed. 
SEC. 6. REPEAL OF MA REGIONAL PLAN STABILIZATION 
FUND. 
(a) IN GENERAL.—Section 1858 of the Social Secu-
rity Act, as added by section 221(c) of the Medicare Pre-
scription Drug, Improvement, and Modernization Act of 
2003 (Public Law 108–173), is amended—
(1) by striking subsection (e); 
(2) by redesignating subsections (f), (g), and 
(h) as subsections (e), (f), and (g), respectively; and 
(3) in subsection (e), as so redesignated, by 
striking ‘‘subject to subsection (e),’’. 
(b) CONFORMING AMENDMENT.—Section 1851(i)(2) 
of the Social Security Act (42 U.S.C. 1395w–21(i)(2)), as 
amended by section 221(d)(5) of the Medicare Prescrip-
tion Drug, Improvement, and Modernization Act of 2003 
(Public Law 108–173), is amended by striking ‘‘1858(h)’’ 
and inserting ‘‘1858(g)’’. 
SEC. 7. REPEAL OF COST CONTAINMENT PROVISIONS. 
Subtitle A of title VIII of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Pub-
lic Law 108–173) is repealed and any provisions of law
amended by such subtitle are restored as if such subtitle 
had not been enacted.
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