H.R. 3069 — Medicare for All Act (As Amended) - A BILL
Reader's Guide — Color Key
Text in BLACK is the original language of H.R. 3069 as introduced April 29, 2025 — unchanged.
Text in BLUE represents new amendments and additional sections that Barry has added to strengthen the bill.
Shaded blue amendment boxes flag each addition. All Table of Contents entries are live links.
To establish an improved Medicare-for-All national health insurance program.
Ms. Jayapal (for herself, Mrs. Dingell, Ms. Adams, Ms. Ansari, Ms. Balint, Ms. Barragán, Mr. Bell, Mr. Beyer, Ms. Bonamici, Mr. Boyle of Pennsylvania, Ms. Brown, Mr. Carbajal, Mr. Carson, Mr. Carter of Louisiana, Mr. Casar, Mrs. Cherfilus-McCormick, Ms. Chu, Ms. Clarke of New York, Mr. Cleaver, Mr. Cohen, Ms. Crockett, Mr. Davis of Illinois, Ms. DeGette, Mr. Deluzio, Mr. DeSaulnier, Ms. Dexter, Mr. Doggett, Ms. Escobar, Mr. Espaillat, Mrs. Foushee, Ms. Lois Frankel of Florida, Ms. Friedman, Mr. Frost, Mr. Garamendi, Mr. Garcia of California, Mr. García of Illinois, Mr. Goldman of New York, Mr. Gomez, Mr. Green of Texas, Mrs. Hayes, Ms. Hoyle of Oregon, Mr. Huffman, Mr. Jackson of Illinois, Ms. Jacobs, Mr. Johnson of Georgia, Ms. Kamlager-Dove, Mr. Keating, Ms. Kelly of Illinois, Mr. Kennedy of New York, Mr. Khanna, Ms. Lee of Pennsylvania, Ms. Leger Fernandez, Mr. Levin, Mr. Lieu, Ms. Lofgren, Ms. McCollum, Mr. McGarvey, Mr. McGovern, Mrs. McIver, Mr. Meeks, Ms. Meng, Mr. Mfume, Mr. Min, Mr. Mullin, Mr. Nadler, Mr. Neguse, Ms. Norton, Ms. Ocasio-Cortez, Ms. Omar, Mr. Pallone, Mr. Panetta, Ms. Pingree, Mr. Pocan, Ms. Pressley, Mr. Quigley, Mrs. Ramirez, Ms. Randall, Mr. Raskin, Ms. Rivas, Ms. Salinas, Ms. Sánchez, Ms. Schakowsky, Mr. Scott of Virginia, Mr. Sherman, Ms. Simon, Mr. Smith of Washington, Ms. Stansbury, Mr. Swalwell, Mr. Takano, Mr. Thanedar, Mr. Thompson of Mississippi, Mr. Thompson of California, Ms. Titus, Ms. Tlaib, Ms. Tokuda, Mr. Tonko, Mrs. Trahan, Mr. Vargas, Ms. Velázquez, Ms. Waters, Mrs. Watson Coleman, Ms. Williams of Georgia, Ms. Wilson of Florida, Mr. Harder of California, Mr. Ivey, and Mr. Torres of New York) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, Rules, Oversight and Government Reform, Armed Services, and the Judiciary, 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.
To establish an improved Medicare-for-All national health insurance program. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
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:
Establishment of the Program; Universal Coverage; Enrollment
Establishment of the Medicare for All Program
There is hereby established a national health insurance program to provide comprehensive protection against the costs of health care and health-related services, in accordance with the standards specified in, or established under, this Act.
Universal Coverage
(a) In General.Every individual who is a resident of the United States is entitled to benefits for health care services under this Act. The Secretary shall promulgate a rule that provides criteria for determining residency for eligibility purposes under this Act.
(b) Treatment of Other Individuals.The Secretary may make eligible for benefits other individuals not described in subsection (a), and regulate the eligibility of such individuals, to ensure that every person in the United States has access to health care. In regulating such eligibility, the Secretary shall ensure that individuals are not allowed to travel to the United States for the sole purpose of obtaining health care items and services provided under this Act.
Freedom of Choice
Any individual entitled to benefits under this Act may obtain health services from any institution, agency, or individual qualified to participate under this Act.
Non-Discrimination
(a) In General.No person shall, on the basis of race, color, national origin, age, disability, marital status, citizenship status, primary language use, genetic conditions, previous or existing medical conditions, religion, or sex — including sex stereotyping, gender identity, sexual orientation, and pregnancy and related medical conditions (including termination of pregnancy) — be excluded from participation in or be denied the benefits of the program (except as expressly authorized by this Act for enforcing eligibility standards under section 102), or be subject to any reduction of benefits or other discrimination by any participating provider, or any entity conducting, administering, or funding a health program or activity, including contracts of insurance, pursuant to this Act.
(b) Claims of Discrimination.The Secretary shall establish a procedure for adjudication of administrative complaints alleging a violation of subsection (a). Any person aggrieved may file suit in any district court having jurisdiction, concurrently with administrative remedies. If the court finds a violation, it may grant compensatory and punitive damages, declaratory relief, injunctive relief, attorneys' fees and costs, or other relief as appropriate.
(c) Continued Application of Laws.Nothing in this title shall be construed to invalidate or limit any rights, remedies, procedures, or legal standards available under section 1557 of the Patient Protection and Affordable Care Act, title VI or title VII of the Civil Rights Act of 1964, title IX of the Education Amendments of 1972, section 504 of the Rehabilitation Act of 1973, or the Age Discrimination Act of 1975, nor to supersede State laws providing additional protections.
Enrollment
(a) In General.The Secretary shall provide a mechanism for enrollment of individuals eligible for benefits, including automatic enrollment at the time of birth in the United States (or upon establishment of residency); enrollment of all eligible individuals as of the dates described in section 106; and enrollment of individuals made eligible under section 102(b).
(b) Issuance of Universal Medicare Cards.In conjunction with enrollment, the Secretary shall provide for issuance of a Universal Medicare card for identification and claims processing. The card shall not include an individual's Social Security number.
Effective Date of Benefits
(a) In General.Except as provided in subsection (b), benefits shall first be available for items and services furnished 2 years after the date of enactment.
(b) Coverage for Certain Individuals.For any eligible individual who has not yet attained age 19, or who has attained age 55, as of the date 1 year after enactment, benefits shall first be available as of such date. Any person eligible under this subsection may opt to maintain coverage described in section 901, private coverage, or coverage offered under subtitle A of title X until the date in subsection (a).
Prohibition Against Duplicating Coverage
(a) In General.Beginning on the effective date in section 106(a), it shall be unlawful for a private health insurer to sell coverage that duplicates the benefits provided under this Act, or for an employer to provide benefits to an employee, former employee, or their dependents that duplicate the benefits provided under this Act.
(b) Construction.Nothing in this Act prohibits the sale of coverage for additional benefits not covered by this Act, including benefits an employer may provide to employees or their dependents.
Comprehensive Benefits, Including Preventive and Long-Term Care
Comprehensive Benefits
(a) In General.Subject to the other provisions of this title and titles IV through IX, individuals enrolled under this Act are entitled to payment by the Secretary to an eligible provider for the following if medically necessary or appropriate: hospital services (inpatient and outpatient, including 24-hour emergency services and inpatient prescription drugs); ambulatory patient services; primary and preventive services, including chronic disease management; prescription drugs and medical devices, including all FDA-approved contraceptive items; mental health and substance use treatment, including inpatient care; laboratory and diagnostic services; comprehensive reproductive care, including abortion, contraception, and assistive reproductive technology; maternity and newborn care; comprehensive gender-affirming health care; oral health, audiology, and vision services; rehabilitative and habilitative services and devices; emergency services and transportation; early and periodic screening, diagnostic, and treatment services; necessary transportation for persons with disabilities, older individuals with functional limitations, or low-income individuals; long-term care services and supports (section 204); hospice care; services by a licensed marriage and family therapist or licensed mental health counselor; and any such service furnished via telehealth, to the extent practical.
(b) Revision.The Secretary shall, at least annually, evaluate whether the benefits package should be improved and make recommendations to Congress. Such recommendations may not include eliminating any benefit.
(c) Hearings.The Committees on Energy and Commerce and Ways and Means shall, not less than annually, hold a hearing on the Secretary's recommendations.
(d) Complementary and Integrative Medicine.The Secretary shall consult with the Director of the National Center for Complementary and Integrative Health to identify practices appropriate to include and barriers to their provision.
(e) States May Provide Additional Benefits.States may provide additional benefits for residents, and benefits to individuals not eligible under this Act, at State expense, subject to section 1102.
No Cost-Sharing; Other Limitations
(a) In General.The Secretary shall ensure that no cost-sharing — including deductibles, coinsurance, copayments, or similar charges — is imposed on any individual for benefits provided under this Act.
(b) No Balance Billing.No provider may impose a charge to an enrolled individual for covered services.
(c) No Prior Authorization.Benefits shall be covered without prior authorization determination and without limitation through step therapy protocols.
Exclusions and Limitations
(a) In General.Benefits are not available unless they meet the standards developed by the Secretary under section 201(a).
(b) Experimental Items and Services.The Secretary shall make national coverage determinations for experimental items and services, consistent with the Social Security Act process, and establish an appeals process.
(c) Application of Practice Guidelines.Where HHS recognizes a national practice guideline, items and services provided in accordance are deemed to meet the standards. A treating professional may override guidelines when consistent with medical necessity and the individual's wishes.
Coverage of Long-Term Care Services
(a) In General.Individuals are entitled to long-term services and supports, with payment to an eligible provider, if medically necessary for a condition causing a functional limitation in activities of daily living or a similar need in instrumental activities of daily living.
(c) Services and Supports.Such services shall be tailored to need through assessment, prioritize home- and community-based services over institutionalization, enable the least restrictive and most integrated setting, be of equal quality and accessibility across regions, and provide the option of self-direction.
(d) Public Consultation.In developing regulations, the Secretary shall consult an advisory commission including people with disabilities and older adults who use such services, their representatives, providers including family caregivers and organized labor, disability rights organizations, and academic researchers.
Provider Participation
Provider Participation and Standards; Whistleblower Protections
(a) In General.An individual or entity furnishing a covered item or service is not a qualified provider unless it is qualified under section 302, has filed a participation agreement under subsection (b), and meets applicable qualifications under section 1866 of the Social Security Act.
(b) Requirements in Participation Agreement.An agreement shall provide that items and services be furnished without discrimination; that no charge be made other than payment authorized by this Act; that the provider furnish information required by the Secretary; and that, for non-individual providers, no board member, executive, or administrator receives compensation from, owns investments in, or serves on the board of any entity that contracts with or provides items or services to such provider.
(c) Whistleblower Protections.No person may discharge or discriminate against any employee for notifying the Secretary or employer of an alleged violation, refusing to engage in unlawful practice, testifying before Congress, or assisting in any proceeding.
Qualifications for Providers
(a) In General.A provider is qualified if licensed or certified in the State where the individual is located and meets that State's law and applicable Federal law.
(c) Minimum Provider Standards.The Secretary shall establish national minimum standards for quality, including adequacy and quality of facilities; mandatory minimum safe registered-nurse-to-patient staffing ratios and optimal staffing for physicians and others; training and competence; comprehensiveness and continuity; patient waiting time, access, and preferences; and performance. A State may establish additional standards.
(d) Federal Providers.Any provider qualified through the VA, the Indian Health Service, or the uniformed services is a qualifying provider for any individual who qualifies under applicable Federal law.
Use of Private Contracts
(a)This section applies beginning 2 years after enactment.
(b) Participating Providers.A provider with an agreement under section 301 may not bill or enter any private contract for any item or service that is a benefit under this Act. Such providers may enter private contracts for non-covered items only if the contract is in writing, signed before service, not entered during an emergency, and clearly indicates the individual agrees not to submit a claim, to be responsible for payment, and acknowledges the provider acts outside the scope of this Act.
(c) Nonparticipating Providers.A provider with no agreement may enter private contracts subject to written requirements and an affidavit filed with the Secretary. If such a provider knowingly and willfully submits a claim, the contract is null and void and no payment shall be made for any item or service furnished during the 2-year period beginning when the affidavit was signed.
Administration
Administration
(a) General Duties.The Secretary shall develop policies, procedures, guidelines, and requirements to carry out this Act, including eligibility; enrollment; benefits; provider standards and qualifications; levels of funding; payment methods consistent with subtitle B; appeals of coverage determinations; capital expenditure and service-delivery planning; health professional education funding; regional planning; and other necessary regulations.
(b) Uniform Reporting; Annual Report.The Secretary shall establish uniform State reporting requirements and national standards for an adequate national database, and beginning 2 years after enactment shall annually report to Congress on implementation, enrollment, benefits, expenditures and financing, cost containment, quality, utilization, per-capita costs, population health differences, transition problems, and opportunities for improvement.
(c) Audits.The Comptroller General shall conduct an audit of HHS every fifth fiscal year following the effective date to determine program effectiveness, and submit a report to Congress on each audit.
Annual Audits Replace Five-Year Cycle
Section 401(c)(1) is hereby amended by striking "every fifth fiscal year" and inserting "annually". The Comptroller General shall conduct an audit of the Department of Health and Human Services in each fiscal year following the effective date of this Act.
A program of this scale — administering health care for the entire United States population — cannot wait five years for an audit. Annual audits ensure rapid identification of waste, fraud, and inefficiency. The cost is trivial relative to the program's size and is dwarfed by the savings discovered through more frequent oversight.
Consultation
The Secretary shall consult with Federal agencies, Indian tribes and urban Indian health organizations, and private entities — labor organizations representing health care workers, professional societies, national associations, medical schools and academic health centers, consumer groups, and business organizations — in formulating guidelines, regulations, policy initiatives, and information gathering.
Regional Administration
(a)The Secretary shall establish and maintain regional offices to promote adequate access to, and efficient use of, tertiary care facilities, equipment, and services. (b)Each office shall have one regional director appointed by the Secretary; one deputy to represent Indian and Alaska Native tribes in the region, if any; and one deputy to oversee long-term services and supports. (c)Each director shall provide an annual health care needs assessment, recommend changes in provider reimbursement, and establish a quality assurance mechanism to minimize both underutilization and overutilization.
Beneficiary Ombudsman
The Secretary shall appoint a Beneficiary Ombudsman with expertise in health care and in education of and assistance to enrolled individuals. The Ombudsman shall receive complaints, grievances, and requests for information; provide assistance including in seeking an appeal; and submit annual reports to Congress and the Secretary.
Conduct of Related Health Programs
In performing functions regarding health personnel education and training, health research, environmental health, disability insurance, vocational rehabilitation, regulation of food and drugs, and all other health matters, the Secretary shall direct the Department's activities toward contributions to the health of the people complementary to this Act.
Application of Federal Sanctions to All Fraud and Abuse
The following sections of the Social Security Act shall apply to this Act in the same manner as to title XVIII or State plans under title XIX: Section 1128 (exclusion of individuals and entities); 1128A (civil monetary penalties); 1128B (criminal penalties); 1124 (disclosure of ownership); 1126 (disclosure of certain owners); and 1877 (physician referrals).
Quality Assessment
Quality Standards
(a) In General.All standards and quality measures shall be implemented and evaluated by the Center for Clinical Standards and Quality of CMS (the "Center"), or such other agency the Secretary determines appropriate, in coordination with the Agency for Healthcare Research and Quality and other HHS offices.
(b) Duties of the Center.The Center shall review each practice guideline developed under part B of title IX of the Public Health Service Act; review each standard of quality, performance measure, and medical review criterion (mechanisms that discriminate against people with disabilities are prohibited in any value or cost-effectiveness assessments); adopt methodologies for profiling patterns of practice; develop minimum criteria for external quality reviews; and submit an annual report to the Secretary.
Addressing Health Care Disparities
(a) Evaluating Data Collection.The Center shall evaluate approaches for collecting data, with existing quality reporting, allowing ongoing, accurate, and timely collection of data on disparities by race, ethnicity, national origin, primary language, age, disability, sex (including gender identity and sexual orientation), geography, or socioeconomic status — while protecting privacy and minimizing burden.
(b) Reports to Congress.Not later than 18 months after benefits first become available, the Center shall report on approaches for identifying and collecting disparities data and recommendations on reporting quality measures; and every 4 years thereafter shall report with recommendations. (c)Not later than 2 years after benefits first become available, the Secretary shall implement the identified approaches.
Mental Health Workforce Mandate
(a) In General.The Secretary shall establish and enforce minimum provider-to-population ratios for mental health and substance use disorder services in every region: one licensed mental health provider per 1,500 residents in urban areas and one per 2,500 in rural areas, with parity provisions for child and adolescent specialists.
(b) Workforce Build-Out.There is hereby appropriated such sums as necessary, but not less than $8 billion annually for the first five fiscal years, to fund tuition forgiveness, residency expansion, loan repayment, and salary support for licensed clinical social workers, psychiatric nurse practitioners, psychiatrists, psychologists, licensed marriage and family therapists, licensed mental health counselors, and certified substance use disorder counselors.
(c) Enforcement.Regional directors shall publish quarterly reports on provider-to-population ratios. Any region failing to meet the standard for two consecutive quarters shall trigger an automatic supplemental appropriation from the reserve fund under section 601(a)(2)(G) sufficient to close the gap within 24 months.
The current mental health crisis cannot be solved by insurance coverage alone if there are no providers. This section creates an enforceable, measurable workforce mandate with real funding behind it.
Patient Safety Rapid Response
(a) In General.The Secretary shall establish a Patient Safety Rapid Response Authority empowered to act on patient safety complaints, sentinel events, and quality-of-care failures within 30 days of credible report, modeled on the CMS Immediate Jeopardy determination process.
(b) Determination Timeline.Within 30 days of a credible complaint, the Authority shall complete on-site investigation, make a written determination of whether a violation occurred, and impose corrective action or sanctions if warranted. There shall be no extensions absent extraordinary circumstances documented in writing.
(c) Sanctions.Available sanctions include monetary penalties up to $500,000 per violation, suspension of new admissions until correction, termination of the participation agreement under section 301, and referral for criminal prosecution under section 411 where warranted.
(d) Public Disclosure.All final determinations shall be published on a publicly accessible database within 14 days of issuance, including the provider's name, the nature of the violation, and the sanction imposed.
Patient safety complaints currently disappear into bureaucratic processes lasting years. A 30-day determination timeline with real teeth ensures providers face consequences while patients can still benefit from the protection.
Health Budget; Payments; Cost Containment Measures
National Health Budget
(a) National Health Budget.By not later than September 1 of each year, beginning the year prior to benefits first becoming available, the Secretary shall establish a national health budget specifying total expenditures: an operating budget; a capital expenditures budget; a special projects budget; quality assessment activities under title V; health professional education; administrative costs; a reserve fund; and prevention and public health activities. The Secretary shall allocate funds so the operating budget allows every provider to meet patient needs; the special projects budget meets needs in underserved areas; quality assessment receives a fair allocation; and education expenditures meet the need for covered services.
(b) Temporary Worker Assistance.For up to 5 years following the date benefits first become available, at least 1 percent of the budget shall be allocated to assistance for workers in health-insurance administration who may experience economic dislocation, including wage replacement, retirement benefits, job training and placement, preferential hiring, and education benefits.
(c) Reserve Fund.The reserve fund shall respond to costs of an epidemic, pandemic, natural disaster, or other health emergency, or market-shift adjustments related to patient volume.
(d) Supplemental Indian Health Service Allocation.The Secretary shall annually determine the need to provide supplemental funds to Indian Health Services.
Payments to Institutional Providers Based on Global Budgets
(a) In General.Not later than the beginning of each fiscal quarter, the Secretary shall pay each institutional provider (including hospitals, skilled nursing facilities, FQHCs, and independent dialysis facilities) a lump sum considered payment in full for all operating expenses. The regional director shall quarterly review performance of the agreement and negotiated global budget and determine whether adjustments are warranted.
(b) Payment Amount.The amount shall be determined before the start of each fiscal year through negotiations between the provider and the regional director, based on historical volume; actual expenditures; projected changes; wages including increases for mandatory minimum safe nurse-to-patient ratios; the provider's maximum capacity; education and prevention programs; and permissible adjustments for factors such as increased primary care access, decreasing disparities, emergent epidemic conditions, or new patient-care programs. Payment may not compensate any board member, executive, or administrator with any interest or relationship prohibited under section 301(b)(2).
(d) Operating Expenses.Operating expenses include wages and salary costs for clinicians and ancillary staff, clinician-administered pharmaceuticals, infectious-disease preparedness including a 365-day stockpile of personal protective equipment, medical devices and supplies, and patient care and education programs.
Payment to Individual Providers Through Fee-for-Service
(a) In General.For a provider not described in section 611(a), payment shall be made under the fee schedule in subsection (b), considered payment in full; such a provider may not charge the individual any amount. (b) Fee Schedule.Not later than 1 year after enactment, the Secretary shall establish a national fee schedule, evaluate its effectiveness, and update it annually, considering amounts payable under title XVIII and the expertise and value of services. (c)The Secretary shall establish a uniform national system for electronic billing. (d)Each regional director shall establish a physician practice review board to assure quality, cost effectiveness, and fair reimbursements.
Anti-Corruption Safeguards on Institutional Payments
(1) National Fee Schedule Timeline.Notwithstanding section 612(b), the Secretary shall publish the initial national fee schedule not later than 6 months after enactment, with a public comment period and final publication not later than 9 months after enactment.
(2) Quarterly Global Budget Payments.Institutional providers paid under section 611 shall receive quarterly global budget payments calculated by reference to the national fee schedule, adjusted for patient volume, severity, and case mix as determined by the regional director.
(3) Compensation Ceilings.The following ceilings apply to all persons paid in whole or part with funds under this Act:
(A) Clinical Providers.No individual clinical provider may receive total annual compensation over $1,500,000 from all sources combined under this Act. Higher base compensation within this ceiling is expressly permitted for more highly skilled specialties such as neurosurgery, cardiothoracic surgery, and orthopedic surgery. Extraordinary clinical performance shall be rewarded through bonuses earned under section 806, which are excluded from this ceiling. Compensation in excess of $1,500,000 (exclusive of section 806 bonuses) shall be returned to the Universal Medicare Trust Fund.
(B) Administrators and Non-Clinical Staff.No administrator, manager, or other non-clinical employee may receive total annual compensation over $250,000, to prevent the accumulation of large numbers of highly paid administrators at taxpayer expense. Public dollars are for care, not for administrative empire-building.
(C) Highest Executive Administrator.A single highest-ranking executive administrator per institutional provider or regional office may receive total annual compensation not to exceed $450,000. No other administrator may exceed the $250,000 ceiling, and no institution may designate more than one position for the $450,000 ceiling.
(D) Enforcement.Any compensation paid in excess of these ceilings shall be recovered and returned to the Universal Medicare Trust Fund. Knowing or willful evasion — including through deferred compensation, consulting arrangements, or related-party payments — constitutes a violation enforceable under section 411 and subjects the responsible executives and board members to personal liability.
(4) Anti-Corruption Safeguards.The Secretary shall implement: (A) Monthly Reconciliation of every provider's actual service delivery against budgeted payments, with discrepancies over 5 percent triggering automatic audit; (B) Monthly Service Reports detailing services rendered, patient counts, staffing levels, and deviations, with false reports constituting a section 411 violation; (C) a Real-Time Audit System with continuous monitoring, automatic flagging of anomalies, and immediate referral of suspected fraud to the Department of Justice; and (D) Personal Liability for Fraud, holding executives, board members, and senior administrators personally liable under 18 U.S.C. § 1347 for knowing or reckless false reports, billing, or certifications, including disgorgement of compensation, civil penalties, and where warranted criminal prosecution.
A program disbursing trillions of dollars annually cannot rely on after-the-fact discovery of fraud. Monthly reconciliation, real-time monitoring, and personal liability for executives — not just the corporate entity — ensure the people making decisions about other people's health dollars face direct consequences for misconduct.
Ensuring Accurate Valuation of Services
Section 1848(c)(2) of the Social Security Act is amended to require the Secretary to establish, document, and make publicly available, in consultation with the Office of Primary Health Care, a standardized process for reviewing the relative values of physicians' services. Section 1848(c)(2) is further amended to provide for review every 4 years (rather than 5) and annual identification of misvalued codes, in consultation with the Medicare Payment Advisory Commission. The Comptroller General shall periodically audit the review and shall have unrestricted access to all deliberations, records, and data.
Payment Prohibitions; Capital Expenditures; Special Projects
(a) Sense of Congress.It is the sense of Congress that tens of millions of people in the United States do not receive healthcare services while billions of dollars that could be spent on care are diverted to profit. There is a moral imperative to correct the deficiencies in our current health system and to eliminate profit from the provision of health care.
(b) Prohibitions.Payments may not take into account, fund, or be used for: marketing of the provider; the profit or net revenue of the provider; incentive payments or bonuses based on patient utilization; any prohibited agreement; or political contributions prohibited under section 317 of the Federal Election Campaign Act of 1971.
(c)–(e) Capital and Special Projects.The Secretary shall pay sums for capital expenditures, prioritizing projects that improve service in medically underserved areas or address disparities, and shall not fund capital projects financed through diversion of non-program funding that reduces patient care. Providers may not co-mingle operating and capital funds. The Secretary shall allocate to each regional director sums for special projects including construction, renovation, or staffing of facilities in rural, underserved, or shortage areas.
(f)The Secretary may not utilize any quality metrics or standards to establish provider payment methodologies, modifiers, or adjustments under this title.
Office of Health Equity
Title XVII of the Public Health Service Act is amended to establish, in the Office of the Secretary, an Office of Health Equity, headed by a Director, to ensure coordination across the Department's programs with respect to health equity. The Director shall monitor and publish data on the disproportionate burden of disease and death among people of color, barriers to access, and disparities in quality and utilization; develop and promote policies including cultural competence training and workforce diversity; consult with Indian Tribes and Urban Indian organizations; publish an annual report; and establish a centralized electronic repository. No personally identifiable information collected shall be disclosed or used for any law enforcement or immigration purpose.
Office of Primary Care
Title XVII is further amended to establish, in the Office of Health Equity, an Office of Primary Health Care, headed by a Director, to increase access to high-quality primary care, particularly in underserved areas. The Director shall publish national goals; coordinate health professional education policies; monitor the number and specialties pursuing primary care; develop policies expanding primary care practitioners, registered nurses, advanced practice clinicians, and dentists; and consult on allocation of the special projects budget.
Payments for Prescription Drugs and Approved Devices and Equipment
The prices paid for covered pharmaceuticals, medical supplies, technologies, and necessary equipment shall be negotiated annually by the Secretary. Notwithstanding any other provision of law, the Secretary shall negotiate with manufacturers the prices that may be charged during a negotiated price period, taking into account comparative clinical and cost effectiveness; budgetary impact; the number of similarly effective drugs; and total revenues from global sales and associated R&D investment.
Competitive Licensing Authority.Notwithstanding any exclusivity under the Federal Food, Drug, and Cosmetic Act, the Public Health Service Act, or any other law, if the Secretary is unable to negotiate an appropriate price, the Secretary shall authorize use of any patent, clinical trial data, or other Federal exclusivity as appropriate for manufacturing such drug for sale under the Program. Any entity using a competitive license shall provide reasonable compensation to the exclusivity holder. Until 1 year after a drug is approved under a competitive license, the Program shall not pay more than the average of prices available from the manufacturer in the ten OECD countries with the largest GDP whose per capita income is not less than half that of the United States.
Universal Medicare Trust Fund
Universal Medicare Trust Fund
(a) In General.There is hereby created on the books of the Treasury a trust fund to be known as the Universal Medicare Trust Fund, consisting of such gifts and bequests as may be made and such amounts as may be deposited in, or appropriated to, the Trust Fund as provided in this Act.
(b) Appropriations Into Trust Fund.There are appropriated to the Trust Fund for each fiscal year, beginning with the year that includes the date benefits first become available, amounts equivalent to 100 percent of the net increase in revenues attributable to the amendments made by sections 801 and 902. For the fiscal year containing January 1 of the first year following enactment, there is appropriated an amount equal to the aggregate amounts appropriated for the preceding fiscal year for Medicare; Medicaid; the Federal Employees Health Benefits program; the purchased care component of TRICARE; the maternal and child health program; vocational rehabilitation; drug abuse and mental health services; and other Federal programs to the extent they pay for health services.
(c)–(d)The provisions of subsections (b) through (i) of section 1817 of the Social Security Act shall apply to the Trust Fund. Any amounts remaining in the Federal Hospital Insurance Trust Fund or the Federal Supplementary Medical Insurance Trust Fund, after claims under title XVIII are completed, shall be transferred into the Universal Medicare Trust Fund.
Graduated Employer Health Contribution
There is hereby imposed on every employer a graduated health contribution on wages paid to employees, scaled by employer size. No employer is categorically exempt; the only employers that do not contribute under this section are those with gross annual revenue below $500,000 that operate at a loss. The graduated payroll rate structure is as follows:
- 1Under $200,000 in gross revenue — if profitable0.5% payroll
- 2Under $200,000 in gross revenue — operating at a lossNo contribution
- 3$200,000 to $500,000 in gross revenue — if profitable0.75% payroll
- 4$200,000 to $500,000 in gross revenue — operating at a lossNo contribution
- 5$500,000 to $2,500,000 in gross revenue1.5% payroll
- 6$2,500,000+ to $5,000,000 in gross revenue2.5% payroll
- 7$5,000,000+ to $10,000,000 in gross revenue3.5% payroll
- 8500 to 4,999 employees and revenue above $10 million5.5% payroll
- 95,000 or more employees7.5% payroll
The Secretary of the Treasury shall adjust all thresholds annually for inflation beginning in Year 3. The corporate profit levy is set out separately in Section 705. Estimated annual revenue — employer payroll contribution: ≈ $500 billion Estimate.
Individual Income-Based Premium
Every household with annual income below $50,000 is fully exempt from any contribution under this section. No exceptions, no paperwork, no means testing beyond income verification already conducted by the Internal Revenue Service. A family earning $49,999 pays nothing.
Every household with annual income between $50,000 and $100,000 shall contribute $100 per month to the Universal Medicare Trust Fund. The employer of each contributing employee shall match this dollar-for-dollar. Combined annual contribution per worker: $2,400 ($1,200 employee + $1,200 employer).
A family earning $65,000 currently pays an average of $6,296 per year in employee premium contributions plus $3,564 out-of-pocket; under this structure they pay $1,200. Their employer, who currently pays over $13,000, pays $1,200. Both save money; both get better coverage. Estimated annual revenue (net of tax offsets): $79 billion Estimate.
High-Earner Contribution
Every employee earning in excess of $100,000 annually shall contribute $150 per month to the Universal Medicare Trust Fund, matched dollar-for-dollar by the employer, for a combined contribution of $300 per month. This contribution is in addition to the employer payroll contribution under Section 702.
A worker earning $120,000 contributes $1,800 per year; their employer matches $1,800. The worker currently pays an average of $7,884 per year in employer-sponsored premium contributions; under this structure they pay $1,800 — a savings of $6,084 for the employee alone. Estimated annual revenue (net of tax offsets): $135 billion Estimate.
Excess Corporate Profit Levy
A levy shall be imposed on the net profits of corporations as follows, applied on profits above each threshold only. This is the sole corporate profit levy under this Act; it complements, and does not duplicate, the employer payroll contribution of Section 702.
- ①Annual net profit exceeding $500 million3% on excess
- ②Annual net profit exceeding $1 billion6% on excess
- ③Annual net profit exceeding $10 billion10% on excess
Corporations with annual net profit below $500 million are fully exempt. Small and mid-size businesses are completely unaffected. This places the entire weight on the ultra-profitable: the largest technology corporations, Wall Street financial institutions, energy companies, and pharmaceutical manufacturers — Apple, Microsoft, Google, JPMorgan, Exxon and their peers pay the most.
Note on private health insurers. UnitedHealth Group, CVS Health/Aetna, Cigna, Elevance Health, Humana, Centene, and all other private health insurers whose primary business is selling duplicative coverage are not projected as profit-levy contributors because their core business ceases to exist under Section 107. The approximately $350 billion they collectively extracted annually is recaptured by eliminating their market entirely, not by taxing their continued operation. No transition assistance under Section 601(b) shall be provided to executives, board members, or shareholders of these entities; assistance shall be provided to their rank-and-file employees. Estimated annual profit-levy revenue: $185–220 billion Estimate.
Financial Transactions Tax
A tax of 0.1 percent shall be imposed on the sale or exchange of stocks, bonds, derivatives, and other financial instruments. Individual retail investors with transaction volumes under $25,000 annually, and qualified retirement accounts under sections 401(k) and 403(b), are fully exempt. The Secretary shall promulgate regulations implementing this tax in a manner that does not impede ordinary retirement savings or middle-class wealth accumulation.
Estimated annual revenue: ≈ $78 billion Gov Data — the Congressional Budget Office and Joint Committee on Taxation score a 0.1% financial transactions tax at roughly $777 billion over ten years.
Corporate Tax Restoration
The corporate income tax rate is hereby restored to 28 percent for corporations with annual net income above $10,000,000. Corporations with net income below $10,000,000 retain the current statutory rate. This restoration reverses a portion of the 2017 corporate tax reduction with respect to large profitable corporations only.
Estimated annual revenue: ≈ $100 billion Gov Data — restoring the rate to 28% is scored at roughly $1.0 trillion (Tax Foundation) to $1.4 trillion (Treasury) over ten years; shown here at the conservative end.
Mandatory Tax Reduction Trigger
(a) Automatic Tax Reduction.When the Comptroller General verifies that the Program has achieved net savings of 5, 10, 15, or 20 percent below the CBO baseline projection for total national health expenditures, the corresponding percentage of the additional revenues generated by sections 702 through 707 shall be automatically and proportionally returned to taxpayers through reductions in the rates imposed under those sections.
(b) Implementation.The Secretary of the Treasury shall, within 90 days of each verification, implement the proportional rate reductions for the next succeeding tax year. Such reductions shall be permanent unless reversed by a subsequent verification showing savings have fallen below the relevant threshold.
This section ensures that savings achieved by this Act flow back to the American people rather than being captured by the Federal Government as additional revenue. As the system grows more efficient, taxpayers pay less. The trigger is self-executing and does not require new authorizing legislation.
Conforming Amendments to the Employee Retirement Income Security Act of 1974
Prohibition of Duplicative Employee Benefits; Workers' Compensation Coordination
Part 5 of subtitle B of title I of ERISA is amended by adding a new section 522 providing that, subject to subsection (b), no employee benefit plan may provide benefits that duplicate payment for any items or services for which payment may be made under the Medicare for All Act. Each workers' compensation carrier liable for payment for workers' compensation services furnished in a State shall reimburse the Program for the cost of such services.
Continuation Coverage Requirements Under ERISA
Part 6 of subtitle B of title I of ERISA shall apply only with respect to any employee health benefit plan that does not duplicate payments for any items or services for which payment may be made under this Act. Section 601 of part 6 is amended to provide that subsection (a) shall apply to any group health plan that does not duplicate such payments.
Effective Date of Title
The provisions of and amendments made by this title shall take effect on the date described in section 106(a).
National Health Media Campaign
There is hereby appropriated $15 billion annually for a National Health Media Campaign administered by the Secretary in consultation with the Surgeon General. The campaign shall produce and distribute television, digital, print, and in-school content promoting healthy eating, regular physical activity, smoking cessation, and mental wellness. The campaign shall be aspirational rather than punitive, modeled on the most effective anti-tobacco campaigns of the 1990s and 2000s. The $15 billion is calibrated to match approximately what fast-food and sugary-beverage industries spend annually on advertising to American consumers. Content shall be culturally responsive, available in major languages, and freely available to State and local health departments.
National Wellness Contest System
There is hereby established the National Wellness Contest System, administered by the Secretary, with annual appropriations of $3 billion, including: (1) individual cash prizes of up to $25,000 for verified measurable improvements in health markers including weight loss, blood pressure reduction, cholesterol reduction, blood glucose normalization, and smoking cessation; (2) community grants of $10 million to $50 million to municipalities, counties, tribal governments, or community organizations achieving the greatest aggregate population health improvements; (3) the National Innovation Prize of $1 million awarded annually for the most effective new community-level health intervention; and (4) school competitions awarding equipment, facilities upgrades, and scholarship funds to schools demonstrating the greatest improvement in student fitness, nutrition, and mental wellness metrics.
Healthy Patient Physician Bonus Program
There is hereby established the Healthy Patient Physician Bonus Program with annual appropriations of $8 billion, providing direct bonuses to participating physicians, nurse practitioners, and physician assistants based on measurable improvement in their patients' health outcomes:
(1) $25,000 per provider annually for achieving 10 percent improvement in panel-wide metrics for blood pressure control, diabetes management, weight management, or smoking cessation. (2) $60,000 for 20 percent improvement. (3) $100,000 for 30 percent improvement. (4) $2,500 per documented and verified case of Type 2 diabetes reversal achieved through lifestyle intervention as primary treatment modality.
Eligibility requires completion of 40 hours of continuing medical education in clinical nutrition, behavioral change counseling, and lifestyle medicine each calendar year. Bonus payments are exempt from the individual provider compensation cap established under the Section 612 amendments.
Community Wellness Infrastructure
There is hereby appropriated $12 billion annually for community wellness infrastructure. Funds shall be distributed by regional directors to fund: free community Tai Chi, qigong, yoga, and stretching programs in every county; pickleball, walking, and recreational programs in every community; community gardens and farmers markets, with priority placement in food deserts as defined by the Department of Agriculture; cycling and pedestrian infrastructure; community swimming pools, gymnasiums, and fitness facilities open to all residents at no cost; and culturally specific traditional movement and wellness practices in coordination with the Indian Health Service and tribal governments. Not less than 40 percent of funds shall be directed to communities with social vulnerability index scores in the highest quartile.
Food Environment Reform
There is hereby appropriated $5 billion annually for food environment reform programs administered by the Secretary in consultation with the Secretary of Agriculture:
(1) Ban on Sugar Advertising to Children. No advertisement for any food or beverage containing more than 5 grams of added sugar per serving may be directed at children under 12 in any medium. The Federal Trade Commission shall promulgate regulations not later than 6 months after enactment.
(2) Grocery Subsidies in Food Deserts. Grants and subsidies for the establishment and operation of full-service grocery stores in census tracts designated as food deserts.
(3) SNAP Fresh-Produce Multiplier. The face value of SNAP benefits shall be multiplied 2:1 when used to purchase fresh fruits, fresh vegetables, dried beans, and unprocessed whole grains.
(4) Whole-Food School Lunches. Federal reimbursement rates for school lunch programs shall be increased to fully fund whole-food, scratch-cooked meals using fresh ingredients in every public school. Highly processed and ultra-processed foods shall be phased out of federally reimbursed school meals over a 3-year period.
Outcomes Measurement and Accountability
The Secretary shall publish annual national health outcome reports tracking obesity prevalence, Type 2 diabetes prevalence and incidence, cardiovascular event rates, cancer incidence, infant mortality, life expectancy, and per-capita health expenditures. Each program funded under sections 804 through 808 shall be evaluated annually against pre-established performance metrics. Programs failing to demonstrate measurable progress over two consecutive years shall be modified, redirected, or terminated. Programs demonstrating exceptional results shall be expanded with supplemental appropriations from the reserve fund.
Return on Investment Projections
Based on peer-reviewed public health literature, international comparison data, and modeling derived from the Finland North Karelia Project (which achieved an 85 percent reduction in cardiovascular mortality over 35 years through community-based lifestyle intervention without new drugs or technology), the projected return on the $45 billion annual investment in sections 804 through 808 is: Year 1, $85–120 billion in health expenditure savings; Year 5, $550–750 billion; Year 10, $900 billion to $1.2 trillion — an approximate 27:1 return by Year 10. These projections shall be reviewed and updated annually by the Comptroller General. Estimate / Projection
Additional Conforming Amendments
Relationship to Existing Federal Health Programs
(a) Medicare, Medicaid, and CHIP.With respect to an individual eligible to enroll under this Act, no benefits shall be available under title XVIII for any item or service furnished beginning 2 years after enactment; no individual is entitled to medical assistance under a State plan under title XIX, or child health assistance under title XXI, on or after such date; and no payment shall be made to a State under section 1903(a) or 2105(a) for such assistance. The Secretary shall provide for continuation of benefits for inpatient stays that began before the effective date. All school-related health programs as of January 1, 2019 shall be continued and covered.
(b) FEHBP.No benefits shall be available under chapter 89 of title 5 for items and services furnished to any eligible individual. (c) TRICARE.Nothing affects eligibility under chapter 55 of title 10 for care at uniformed-services facilities; no benefits under the purchased-care component of TRICARE for eligible individuals, except those eligible for and located in regions covered by the TRICARE Overseas Program. (d) Veterans and Native Americans.Nothing affects veterans' eligibility under title 38, or Indians' benefits through the Indian Health Service; no reevaluation of the IHS shall be undertaken without consultation with tribal leaders and stakeholders.
Sunset of Provisions Related to the State Exchanges
Effective 2 years after enactment, the Federal and State Exchanges established under title I of the Patient Protection and Affordable Care Act shall terminate, and any other provision of law that relies upon participation in or enrollment through such an Exchange, including provisions of the Internal Revenue Code of 1986, shall cease to have force or effect.
Sunset of Provisions Related to Pay-for-Performance Programs
Effective on the date described in section 106(a), the Federal pay-for-performance and value-based purchasing programs shall terminate, including the Merit-based Incentive Payment System; incentives for meaningful use of certified EHR technology; alternative payment models; the adult health quality measures program; payment adjustments for health care-acquired conditions; the Pediatric Accountable Care Organization Demonstration Projects; incentive payments for quality reporting; Hospital Value-Based Purchasing; value-based purchasing for skilled nursing facilities and home health agencies; the value-based payment modifier under the physician fee schedule; Medicare shared savings programs; the National Pilot Program on Payment Bundling; the Independence at Home demonstration program; the hospital readmissions reduction program; and the value-based purchasing program for ambulatory surgical centers.
Transition
Medicare for All Transition Over Two Years
Title XVIII of the Social Security Act is amended by adding a new section 1899C providing that every individual who meets the requirements shall be eligible to enroll during the transition period starting one year after enactment, and is entitled to the benefits established under title II. The requirements are that the individual meets the eligibility requirements under title I and has attained the applicable year of age, or is currently enrolled in Medicare at the time of transition. The term "applicable year of age" means one year after enactment, the age of 55 or older, or age 18 or younger. For purposes of section 5000A of the Internal Revenue Code, coverage under this section constitutes minimum essential coverage.
Establishment of the Medicare Transition Buy-In
For the year beginning one year after enactment and ending with the effective date in section 106(a), the Secretary, acting through the Administrator of CMS, shall establish and offer through the Exchanges an option to buy in to the Program (the "Medicare Transition buy-in"), available to any U.S. resident wishing to enroll and to qualified employers. The buy-in shall provide coverage for the benefits required under title II, actuarially equivalent to 90 percent of full actuarial value. Providers shall be reimbursed at rates under the section 612(b) fee schedule, with drug prices at the rates negotiated under section 617. Premiums shall be determined by the Administrator and may vary by family or individual coverage, age, and tobacco status, but not by rating area. Premium assistance tax credits under a graduated table (2.00 percent of income up to 100 percent of poverty, rising to 5.00 percent at 150 percent of poverty and above) and cost-sharing subsidies shall be extended to buy-in enrollees, with parallel rules for Medicaid non-expansion States. This section ceases to have force or effect on the date in section 106(a).
Eliminating the 24-Month Waiting Period for Disability Coverage
Section 226(b) of the Social Security Act is amended to eliminate the 24-month waiting period for Medicare coverage for individuals with disabilities, providing eligibility for each month for which the individual meets the requirements, beginning with the month following the month in which the individual meets such requirements. Conforming amendments are made to section 226, section 1811(2), section 1837(g)(1), and section 7(d)(2)(ii) of the Railroad Retirement Act of 1974. The amendments apply to items and services furnished in months beginning after December 1 following enactment, and before the date 2 years after enactment.
Ensuring Continuity of Care
The Secretary shall ensure that all persons enrolled or seeking to enroll during the transition period are protected from disruptions in their care, including continuity with their current provider teams. During the transition, group health plans and issuers shall not end coverage for an enrollee until all ages are eligible to enroll, except as expressly agreed under the terms of the plan. The Secretary shall ensure persons with disabilities, complex medical needs, or chronic conditions are protected from disruptions, and that plans shall not end coverage nor impose any exclusion on such persons. The Secretary shall consult with disability communities and patient advocacy organizations to ensure the transition buy-in takes continuity of care into account.
Miscellaneous
Definitions
In this Act: "global budget" means the payment negotiated between an institutional provider and the regional director as described in section 611(b); "group practice" has the meaning in section 1877(h)(4) of the Social Security Act; "individual provider" means a supplier as defined in section 1861(d); "institutional provider" means providers of services described in section 1861(u), hospitals as defined in section 1861(e), psychiatric hospitals, rehabilitation hospitals, long-term care hospitals, and independent dialysis and end-stage renal disease facilities; "medically necessary or appropriate" means health care items and services needed or appropriate to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms, as determined by the treating professional; "provider" means an institutional provider or a supplier; "Secretary" means the Secretary of Health and Human Services; "State" means a State, the District of Columbia, or a territory; and "United States" includes the States, the District of Columbia, and the territories.
Rules of Construction
A State or local government may set additional standards or apply other laws with respect to eligibility, benefits, and minimum provider standards, only if such standards provide equal or greater eligibility, provide equal or greater in-person access to benefits, do not reduce access, allow for the effective exercise of professional judgment, and are otherwise consistent with this Act. Nothing in this Act shall be construed to preempt State licensing, practice, or educational laws with respect to health care professionals, nor to diminish or alter the rights or obligations of any employee or employer under any law or collective bargaining agreement.
No Use of Resources for Certain Registration Enforcement
Notwithstanding any provision of Federal or State law, no Federal or State law enforcement official or employee shall use any funds, facilities, property, equipment, or personnel made available pursuant to this Act to investigate, enforce, or assist in the enforcement of any requirement that individuals register with the Federal Government based on religion, national origin, ethnicity, immigration status, or other protected category.
Rural Hospital Preservation and Minimum Access Standards
(a) Minimum Access Standard.The Secretary shall ensure that no resident of the United States is required to travel more than 35 miles by ground transportation to reach an inpatient hospital providing emergency services, obstetric services, and basic acute inpatient care.
(b) Identification of At-Risk Facilities.Within 6 months of enactment, the Secretary shall identify and publish a list of all rural hospitals at risk of closure, including not less than the 600 hospitals identified by the Center for Healthcare Quality and Payment Reform as facing imminent financial distress.
(c) Priority Global Budget Adjustments.Hospitals so identified shall receive priority global budget adjustments under section 611 sufficient to ensure continued operation, including supplemental payments to cover legacy debt, deferred capital expenditures, and minimum staffing. Such adjustments are not subject to the limitation under section 611(b)(3).
(d) New Facility Construction.Where closure cannot be prevented, or the 35-mile standard cannot be met by existing facilities, the Secretary shall use the special projects budget under section 601(a)(2)(C) to fund construction of new rural hospitals, critical access hospitals, freestanding emergency departments, or other facilities sufficient to meet the standard within 36 months.
(e) Workforce Mandate.The Secretary shall ensure adequate staffing through expansion of the National Health Service Corps, loan repayment for clinicians serving in rural areas for not less than 4 years, and supplemental compensation for rural service, coordinated with the section 503 mental health workforce mandates.
Approximately 600 rural hospitals are currently at risk of closure. Closure of a rural hospital is a death sentence for portions of the population it serves. A 35-mile minimum access standard, combined with mandatory priority funding and workforce build-out, prevents this entirely foreseeable catastrophe.
Severability and Litigation Protection (New Title)
Severability
(a) In General.If any provision of this Act, any amendment made by this Act, or the application of any such provision to any person or circumstance, is held to be unconstitutional or otherwise invalid, the remainder of this Act, the remainder of any such amendment, and the application of such provision to other persons or circumstances shall not be affected.
(b) Intent of Congress.Congress declares that each provision of this Act is intended to operate independently. Congress would have enacted each provision separately even in the absence of any other provision found invalid. No court may invalidate the entire Act, any title, any subtitle, or any section on the grounds that any subordinate provision is held invalid.
This provision prevents litigation from being used to dismantle the entire program through challenge of any single subordinate provision. Each provision must stand or fall on its own merits.
Limitation on Injunctive Relief
(a) Prohibition on Nationwide Injunctions Pending Appeal.Notwithstanding any other provision of Federal law, no court of the United States shall issue an injunction, temporary restraining order, or other order that has the effect of freezing operation of this Act in its entirety, freezing operation of any title in its entirety, or preventing the Secretary from continuing to enroll, provide benefits to, or pay providers on behalf of eligible individuals, while a challenge to any particular provision is pending.
(b) Narrow Tailoring Required.Any injunctive relief granted shall be narrowly tailored to address only the specific provision held invalid and only the specific parties before the court. No court may issue any injunction broader than the minimum necessary to remedy the specific harm proven.
(c) Appellate Review.Any injunction issued under this section shall be subject to expedited appellate review, with the Court of Appeals required to render a decision within 45 days of filing of notice of appeal.
These limitations are essential to ensure that opponents cannot use a single sympathetic court in a single district to stop the entire program from delivering benefits to 330 million Americans during years of appeals.
Pro Forma Financial Analysis and Projected Outcomes
Attached to and incorporated into H.R. 3069 as a plain-language explanation of the financial structure — where the money comes from, who pays, how much is raised, and when the program becomes net profitable to the United States.
Drawn from current U.S. government figures (CMS National Health Expenditure Accounts) or official CBO / JCT / Treasury scoring of comparable proposals.
An extrapolation or projection specific to this bill that no government agency has independently scored. These are our best estimates from the most current government data available and may carry significant error. Only the CBO and JCT can produce a binding score.
Where the Revenue Comes From
| Revenue Source | Basis | Annual ($B) |
|---|---|---|
| Redirected federal health programsAnchor: CMS reports the federal government sponsored $1,566B of national health spending in 2023; grown to launch. | Estimate | 1,800 |
| Graduated employer payroll contribution — §702Not gov-scored. Context: private business sponsored ~$894B of NHE in 2023. | Estimate | 500 |
| Capture of the employer premium tax exclusionTax-expenditure value ~$300–350B/yr (JCT / Tax Policy Center). | Estimate | 300 |
| Excess corporate profit levy — §705Bespoke 3/6/10% structure; not scored. | Estimate | 200 |
| High-earner contribution — §704$150/mo + employer match over $100K; not scored. | Estimate | 135 |
| Corporate tax restoration to 28% — §707~$1.0T (Tax Foundation) to $1.4T (Treasury) over 10 yrs; conservative end. | Gov Data | 100 |
| Financial transactions tax (0.1%) — §706CBO/JCT: $777B over 10 yrs ≈ $78B/yr. | Gov Data | 78 |
| Individual income-based premium — §703$100/mo on households $50K–$100K, matched; not scored. | Estimate | 79 |
| Total Annual Revenue | Best Estimate | ≈ 3,192 |
Structural Savings on Day One
Savings captured by design, before prevention results. Every figure is an Estimate from health-policy literature, not government scoring; the overhead and drug figures in particular are contested.
| Source of Day-One Savings | Annual ($B) |
|---|---|
| Private insurance overhead, profit, executive pay | 350 |
| Drug price negotiation — §617 leverage | 270 |
| Consolidation of billing into one system | 255 |
| Elimination of prior-authorization bureaucracy — §202 | 93 |
| Elimination of bad debt and uncompensated-care collections | 55 |
| Total Day-One Structural Savings | 1,023 |
Ten-Year Pro Forma
All figures in billions. Revenue indexed at 2.5% annual growth from the corrected launch figure of $3,192B. The entire table is a projection — every row an Estimate, only as reliable as the inputs above.
| Launch | Yr 2 | Yr 3 | Yr 5 | Yr 7 | Yr 10 | |
|---|---|---|---|---|---|---|
| Total Revenue | 3,192 | 3,272 | 3,354 | 3,523 | 3,702 | 3,986 |
| Net Program Cost | 3,522 | 3,415 | 3,309 | 2,946 | 2,732 | 2,502 |
| Surplus / (Deficit) | (330) | (143) | 45 | 578 | 970 | 1,484 |
Net Program Cost = gross program cost (≈$4,500B, Estimate) less structural savings (Part 2) less accumulating prevention savings, plus the $45B/yr wellness program cost.
When the Program Is Funded
On the corrected revenue, the program reaches its first surplus in Year 3. Every milestone here is an Estimate that moves with the inputs above; only a formal CBO/JCT score can confirm these years.
| Milestone | Year | Annual Result ($B) |
|---|---|---|
| Program launches (transitional deficit) | Year 1 | (330) |
| Deficit narrows as insurers wind down | Year 2 | (143) |
| First surplus — program fully funded | Year 3 | 45 |
| Prevention savings reach stride | Year 5 | 578 |
| Mature steady-state surplus | Year 10 | 1,484 |
Sources Consulted
CMS National Health Expenditure Accounts (2023: $4.9T total; Medicare $1,029.8B; Medicaid $871.7B; federal-sponsor share $1,566.2B; 2024: $5.3T) · Congressional Budget Office / Joint Committee on Taxation (0.1% financial transactions tax ≈ $777B/10 yrs) · U.S. Treasury and Tax Foundation (corporate rate to 28% ≈ $1.0–1.4T/10 yrs) · JCT / Tax Policy Center (employer-sponsored insurance exclusion ≈ $300–350B/yr) · Finland North Karelia Project (community cardiovascular prevention outcomes).