Rep. Rosa DeLauro, D-Conn., introduced the Medicare for America Act on Oct. 30, legislation that would open an expanded Medicare program to every U.S. resident while preserving employer-sponsored coverage.
The bill would also ban prior authorization and step therapy and require site-neutral payments, so services billed through hospital outpatient departments would no longer be paid more than the same care delivered in a physician’s office.
Unlike “Medicare for All” proposals, the bill would not eliminate private insurance. Workers could keep employer plans or switch to Medicare for America, and employers would still have to pay their share of the premium. Remaining employer plans would need to cover dental, vision and hearing. Uninsured residents would be enrolled automatically.
“If you like your current employer coverage, you keep it,” Ms. DeLauro said. “If you want Medicare, it is yours.”
The plan would eliminate deductibles, cap out-of-pocket costs at $3,500 for individuals and $5,000 for households, and cap premiums at 8% of income. People earning less than 200% of the federal poverty level would pay no premiums or out-of-pocket costs. The bill would also ban prior authorization and step therapy.
For providers and payers, the bill would establish all-payer rate setting, requiring providers to accept Medicare for America rates from employer and Medicare Advantage plans. It would raise primary care and mental health payments by at least 30%, mandate site-neutral payments, target Medicare Advantage overpayments and require HHS to negotiate prices for all covered drugs. It would also lift the cap on Medicare-funded residency slots and set safe staffing requirements for hospitals.
Ms. DeLauro’s office said the bill would be funded by repealing HR 1, the One Big Beautiful Bill Act, and by a 5% surtax on income above $500,000, among other measures.
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