TITLE I—ESTABLISHMENT OF THE UNIVERSAL MEDICARE PROGRAM
Establishes a Universal Medicare Program for every resident of the United States, including
the District of Columbia and the territories. Guarantees patients the freedom to choose
their health care provider. Provides for the issuance of Universal Medicare cards that all
residents may use to get the health care they need upon enrollment. Prohibits discrimination against anyone seeking benefits under this act.
Effective date of benefits: For children ages 0 to 18, benefits shall first be available on
January 1 of the first calendar year that begins after enactment; for all others, benefits shall
be made available on January 1 of the fourth calendar year that begins after enactment.

TITLE II—COMPREHENSIVE BENEFITS

Requires coverage of the following benefits: hospital services, including emergency
services and inpatient drugs; ambulatory patient services; primary and preventive services,
including disease management; prescription drugs, medical devices, and biological
products; mental health and substance abuse treatment services, including inpatient care;
laboratory and diagnostic services; comprehensive reproductive, maternity, and newborn
care; pediatrics; oral health, vision, and audiology; rehabilitative and habilitative services
and devices; other items as deemed necessary.
States may provide additional benefits at their expense.
This section eliminates out-of-pocket spending for medical benefits, which includes
deductibles, coinsurance, and copayments. The Secretary may impose limited copayments
for prescription drugs in order to encourage the use of lower-cost generic drugs.
Long-term care coverage for seniors and people with disabilities will continue as it is
currently covered under Medicaid, complete with a maintenance of effort provision; no one
receiving benefits through Medicaid or any other federal or state health program will lose
support.

TITLE III—PROVIDER PARTICIPATION
Requires all providers to sign a participation agreement. Participation agreements may be
terminated by the agency for cause, or by the provider for any reason.
Providers shall be considered qualified if they are properly licensed and certified under
State and federal law to provide such services. Applies Medicare’s current provider
standards.
Allows providers to opt out of the system on an annual basis.

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 TITLE IV—ADMINISTRATION
Establishes this program under the Department of Health and Human Services, run by the
Secretary. Provides for general duties of the Secretary related to the administration, including developing policies, procedures, guidelines, and requirements related to eligibility,
enrollment, benefits, provider participation, payment methods, and data collection.
Provides for a Beneficiary Ombudsman to assist individuals enrolled in the Act.
Applies all current Medicaid fraud provisions to this Act.

TITLE V—QUALITY ASSESSMENT
Requires CMS’ Center for Clinical Standards and Quality, in coordination with the Agency
for Healthcare Research and Quality to review and evaluate all practice guidelines, profile
practices and patterns of health care, conduct quality reviews, and report to the agency on
outcomes research.
Requires the Center to evaluate and address health care disparities, and issue a report to
Congress and the Secretary on such disparities.

TITLE VI—BUDGET AND PROVIDER PAYMENT
Applies Medicare’s current payment structures to Universal Medicare, including payment
reform activities established by the ACA and MACRA.
Requires the agency to create an annual budget, which shall include the cost of covered
health services; quality assessment activities; health professional education expenditures;
administrative costs; innovation; operating and other expenditures; capital expenditures;
and public health activities. For the first five years following the date of enactment, the
budget may also provide transition assistance to health insurance administration workers
who may be displaced because of the implementation of this Act. Provides for a reserve
fund to anticipate natural disasters or other such public health emergencies.
Creates an Office of Primary Health to promote access to primary health care.
Requires the Secretary to negotiate the price of prescription drugs. Requires the Secretary
to establish a prescription drug formulary for the Universal Medicare Program that is
evidence-based and will encourage the use of generic drugs.

TITLE VII—UNIVERSAL HEALTH INSURANCE TRUST FUND

Creates a trust fund for this Act. Includes all current federal health insurance program
receipts, as well as all extra dollars attributed to changes in the Internal Revenue Code.
Prohibits Hyde restrictions from following current appropriated funds into the Trust Fund.

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 TITLE VIII—ERISA CONFORMING AMENDMENTS
Conforming amendments to the Employee Retirement Income Security Act of 1974.
Prohibits employee benefits duplicative of the benefits under the Universal Medicare
Program. Provides for coordination with employers in cases of workers’ compensation.

TITLE IX—RELATIONSHIP TO EXISTING FEDERAL HEALTH PROGRAMS
Provides for a transition from Medicare, Medicaid, FEHB, SCHIP, and any other federal
health insurance program into the Universal Medicare Program.
Nothing in this legislation will impact the eligibility of veterans for the medical benefits and
services provided under the VA, or of Native Americans for the medical benefits and
services provided by or through the Indian Health Service. Those benefits will be kept
intact. Requires HHS to consult with tribal leaders and stakeholders before making any
determination with respect to the Indian Health Service.

TITLE X—TRANSITION
This section sets up a just transition to Universal Medicare. It will immediately improve and
expand Medicare for seniors and people with disabilities by covering dental, vision and
hearing aids which are not covered under current law. Medicare Part A, Part B, and Part D
deductibles would also be eliminated in the first year.
A Medicare Transition plan would be established during the first year to provide affordable
coverage for all Americans and to make sure that no one loses coverage.
During the second year of implementation, the Medicare eligibility age would be reduced
to 45 and to 35 by the third year.
By the fourth year, every individual who is a resident of the United States will be entitled to
benefits for comprehensive health care services and will get a Universal Medicare card that
they can use to receive the health care they need.

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