Posted on 04/26/2019 12:17:41 PM PDT by Brian Griffin
Santa Claus, move over, Bolshevik Bernie and his fellow travelers are packing the presents with their Medicare for All bill, for which you'll get the tax bills:
https://www.congress.gov/bill/116th-congress/senate-bill/1129/text
"Every individual who is a resident of the United States is entitled to benefits for health care services under this Act."
"Except as provided in subsection (b), benefits shall first be available under this Act for items and services furnished on January 1 of the fourth calendar year that begins after the date of enactment of this Act."
"(b) Coverage for children.— (1) IN GENERAL.—For any eligible individual who has not yet attained the age of 19, benefits shall first be available under this Act for items and services furnished on January 1 of the first calendar year that begins after the date of enactment of this Act."
"SEC. 201. Comprehensive benefits. (a) In general.—Subject to the other provisions of this title and titles IV through IX, individuals enrolled for benefits under this Act are entitled to have payment made by the Secretary to an eligible provider for the following items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition: (1) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs. (2) Ambulatory patient services. (3) Primary and preventive services, including chronic disease management. (4) Prescription drugs, medical devices, biological products, including outpatient prescription drugs, medical devices, and biological products. (5) Mental health and substance abuse treatment services, including inpatient care. (6) Laboratory and diagnostic services. (7) Comprehensive reproductive, maternity, and newborn care. (8) Pediatrics, including early and periodic screening, diagnostic, and treatment services (as defined in section 1905(r) of the Social Security Act (42 U.S.C. 1396d(r))). (9) Oral health, audiology, and vision services. (10) Short-term rehabilitative and habilitative services and devices. (11) Emergency services and transportation. (12) Necessary transportation to receive health care services for individuals with disabilities and low-income individuals. (13) Home and community-based long-term services and supports (to be provided in accordance with the requirements for home and community-based settings under sections 441.530 and 441.710 of title 42, Code of Federal Regulations), including— (A) services described in paragraphs (7), (8), (13), (19), and (24) of section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)); (B) home and community-based services described in subsection (c)(4)(B) of section 1915 of the Social Security Act (including habilitation services defined in subsection (c)(5) of such section); (C) self-directed home and community-based services described in subsection (i) of section 1915 of the Social Security Act; (D) self-directed personal assistance services (as defined in subsection (j)(4)(A) of section 1915 of the Social Security Act); and (E) home and community-based attendant services and supports described in subsection (k) of section 1915 of the Social Security Act."
"SEC. 202. No cost-sharing. (a) In general.—The Secretary shall ensure that no cost-sharing, including deductibles, coinsurance, copayments, or similar charges, be imposed on an individual for any benefits provided under this Act, except as described in subsection (b). (b) Exceptions.—The Secretary may set a cost-sharing schedule for prescription drugs and biological products— (1) provided that— (A) such schedule is evidence-based and encourages the use of generic drugs; (B) such cost-sharing does not apply to preventive drugs; (C) such cost-sharing does not exceed $200 annually per individual, adjusted annually for inflation; and (D) such cost-sharing is not imposed on individuals with a household income equal to or below 200 percent of the poverty line for a family of the size involved; and (2) under which the Secretary may exempt brand-name drugs from consideration in determining whether an individual has reached any out-of-pocket limit if a generic version of such drug is available. (c) No balance billing.—Notwithstanding contracts in accordance with section 303, no provider may impose a charge to an enrolled individual for covered services for which benefits are provided under this Act."
"SEC. 204. Coverage of institutional long-term care services under Medicaid .... “(b) Institutional long-Term care services defined.—In this section, the term ‘institutional long-term care services’ means the following: “(1) Nursing facility services for individuals 21 years of age or over described in subparagraph (A) of section 1905(a)(4). “(2) Inpatient services for individuals 65 years of age or over provided in an institution for mental disease described in section 1905(a)(14). “(3) Intermediate care facility services described in section 1905(a)(15). “(4) Inpatient psychiatric hospital services for individuals under age 21 described in section 1905(a)(16). “(5) Nursing facility services described in section 1905(a)(29).
"SEC. 205. Prohibiting recovery of correctly paid Medicaid benefits. Section 1917 of the Social Security Act (42 U.S.C. 1396p) is amended— (1) by amending subsection (a) to read as follows: “(a) No lien may be imposed against the property of any individual prior to his death on account of medical assistance paid or to be paid on his behalf under the State plan, except pursuant to the judgment of a court on account of benefits incorrectly paid on behalf of such individual.”; and (2) by amending subsection (b) to read as follows: “(b) No adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State plan may be made.”.
"SEC. 601. National health budget. (a) National health budget.— (1) IN GENERAL.—By not later than September 1 of each year, beginning with the year prior to the date on which benefits first become available as described in section 106(a), the Secretary shall establish a national health budget, which specifies the total expenditures to be made for covered health care services under this Act.
"SEC. 611. Payments to institutional and individual providers. (a) Application of payment processes under title XVIII.—Except as otherwise provided in this section, the Secretary shall establish, by regulation, fee schedules that establish payment amounts for benefits under this Act in a manner that is consistent with processes for determining payments for items and services under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), including the application of the provisions of, and amendments made by, section 612."
"SEC. 614. Payments for prescription drugs and approved devices and equipment. (a) Negotiated prices.—The prices to be paid for covered pharmaceuticals, medical supplies, and medically necessary assistive equipment shall be negotiated annually by the Secretary. (b) Prescription drug formulary.— (1) IN GENERAL.—The Secretary shall establish a prescription drug formulary system, which shall encourage best-practices in prescribing and discourage the use of ineffective, dangerous, or excessively costly medications when better alternatives are available. (2) PROMOTION OF USE OF GENERICS.—The formulary under this subsection shall promote the use of generic medications to the greatest extent possible. (3) FORMULARY UPDATES AND PETITION RIGHTS.—The formulary under this subsection shall be updated frequently and clinicians and patients may petition the Secretary to add new pharmaceuticals or to remove ineffective or dangerous medications from the formulary. (4) USE OF OFF-FORMULARY MEDICATIONS.—The Secretary shall promulgate rules regarding the use of off-formulary medications which allow for patient access but do not compromise the formulary.
"SEC. 1001. Lowering the Medicare age .... REQUIREMENTS FOR ELIGIBILITY.—The requirements described in this paragraph are the following: “(A) The individual is a resident of the United States. “(B) The individual is— “(i) a citizen or national of the United States; or “(ii) an alien lawfully admitted for permanent residence. “(C) The individual is not otherwise entitled to benefits under part A or eligible to enroll under part A or part B. “(D) The individual has attained the applicable years of age but has not attained 65 years of age. “(4) APPLICABLE YEARS OF AGE DEFINED.—For purposes of this section, the term ‘applicable years of age’ means— “(A) effective January 1 of the first year following the date of enactment of the Medicare for All Act of 2019, the age of 55; “(B) effective January 1 of the second year following such date of enactment, the age of 45; and “(C) effective January 1 of the third year following such date of enactment, the age of 35 .... AMOUNT OFMONTHLY PREMIUMS.—The Secretary shall, during September of each year (beginning with the first September following the date of enactment of the Medicare for All Act of 2019), determine a monthly premium for all individuals enrolled under this section. Such monthly premium shall be equal to 1⁄12 of the annual premium computed under paragraph (2)(B), which shall apply with respect to coverage provided under this section for any month in the succeeding year. “(2) ANNUALPREMIUM.— “(A) COMBINED PERCAPITA AVERAGE FOR ALL MEDICARE BENEFITS.—The Secretary shall estimate the average, annual per capita amount for benefits and administrative expenses that will be payable under parts A, B, and D (including, as applicable, under part C) in the year for all individuals enrolled under this section. “(B) ANNUALPREMIUM.—The annual premium under this subsection for months in a year is equal to the average, annual per capita amount estimated under subparagraph (A) for the year .... ELIGIBILITY FOR PREMIUM ASSISTANCE.—Coverage provided under this section— “(A) shall be treated as coverage under a qualified health plan in the individual market enrolled in through the Exchange where the individual resides for all purposes of section 36B of the Internal Revenue Code of 1986 other than subsection (c)(2)(B) thereof;"
That's most of the key provisions.
I don't understand the premium assistance formulas yet, but Santa Claus will surely be beat by Bernie.
Co-sponsors:
Ms. Baldwin, Mr. Blumenthal, Mr. Booker, Mrs. Gillibrand, Ms. Harris, Mr. Leahy, Mr. Markey, Mr. Merkley, Mr. Schatz, Mr. Udall, Ms. Warren, Mr. Whitehouse, Ms. Hirono, and Mr. Heinrich
I heard someone mention another reason for this proposal. It will bail out the Dem run cities that are about to go bankrupt paying expensive healthcare premiums for their retired workforce.
The fact that this could get 14 co-sponsors is disturbing. The trends are not our friends here.
No co-pays, no deductibles, free medical care for everyone? What’s not to like and vote for in that?
Oh, you’re wondering about the cost? You just had to ruin the party!
benefits shall first be available under this Act for items and services furnished on January 1 of the fourth calendar year that begins after the date of enactment of this Act.”
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Why the 4 year delay for implementation?
What a joke! Medicare is worthless without a supplement. Anyone see a Medicare bill for something that was billed out at $1,000 and Medicare paid $100 or less?
Let’t talk about the government “controlling” who lives and who dies via denial of care. Marxist Big Bro could decide, like Obama, that anyone over a certain age, gets a “pain pill” and no other care.
No wonder Liberals want Medicare for all. Saves them opening up camps to do their dirty work.
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