The "Medicare for America Act of 2024" includes several sections aimed at establishing a new health care system, modifying existing health programs, and implementing targeted reforms. It also addresses tax provisions related to Medicare, along with regulations on drug pricing, and includes provisions for evaluating the outcomes of the bill.

The Secretary of Health and Human Services is required to set up a public health insurance plan that individuals can purchase through federal and state exchanges for the years 2025 and 2026, as part of the Affordable Care Act.

An individual can enroll in the public health plan option if they are eligible to buy health insurance through an Exchange and live in an area where the plan is available, as determined by the Secretary.

The public health plan option is designed to be a qualified health plan that meets specific requirements from the Affordable Care Act, including essential health benefits and reproductive health services like abortion. Additionally, states cannot restrict this plan from providing coverage for these services, and any state law that tries to do so won't apply.

The Secretary must set premium rates for a public health plan that cover costs and are affordable, ensuring no one pays more than 8% of their income. Federal subsidies will fully cover premiums for those earning less than 200% of the poverty line, and provide gradual assistance up to 600% of the poverty line.

The section outlines guidelines for reimbursement rates for health care providers under a public health insurance plan. It specifies that rates for covered services will be based on existing Medicare rates and introduces provisions to include additional benefits like dental and vision care. It ensures provider participation by allowing all eligible health care providers to join, prohibits denial of service due to religious objections, and applies existing prescription drug rules to this plan.

The section establishes an account in the U.S. Treasury to manage the funds for operating a public health plan, appropriates necessary funds from the Treasury, and prohibits states from taxing these funds. It also clarifies that any federal restrictions on funds for reproductive health services do not apply to these appropriated funds.

The bill establishes "Medicare for America," a public health insurance program that will offer comprehensive health benefits to all eligible U.S. residents starting in 2026. It includes automatic enrollment at birth and for those who lack qualified health coverage, covers a wide range of medical services and supplies, and prohibits private insurers from selling plans that duplicate its benefits. The program is funded through taxes and premiums based on income, with subsidies ensuring affordability, and includes various procedural details on enrollment, benefits, cost-sharing, and provider participation.

The Secretary is tasked with creating a public health insurance program called "Medicare for America." Starting in 2026, this program will offer comprehensive health benefits to people who sign up for it each year.

The bill section outlines who is eligible to be automatically enrolled in Medicare for America, specifying criteria for residents, those lawfully present, and individuals eligible for Medicaid. From 2027, various automatic enrollment processes begin, including enrollment at birth, for current Medicare beneficiaries, and for those without other health coverage, with options for small and large employers to facilitate enrollment, and includes an opt-out for those with qualified health coverage.

The section outlines the benefits covered by Medicare for America, which include a wide range of health services such as emergency care, hospitalization, dental and vision care, prescription drugs, and much more. It also prohibits private insurers from selling duplicate coverage, allows states to offer additional benefits, and mandates that covered services do not require prior authorization or step therapy.

Each person enrolled for benefits under this section will pay a monthly premium determined by income and family size, with subsidies available to lower the cost for low-income individuals. The bill also provides options for those with employer contributions and outlines appeal procedures for those facing late enrollment penalties.

Medicare for America provides that enrolled individuals will have their medical costs covered up to 80% for most services and 100% for specific categories like preventive services and emergency care, with no deductibles or lifetime limits. Out-of-pocket expenses are capped based on income, forbidding private contracts and balance billing, while any leftover costs after reaching these caps will be covered entirely, with flexible savings accounts reserved for non-covered services.

The proposed section outlines how the Secretary of Health and Human Services will establish payment rates for healthcare providers and negotiate drug prices under the "Medicare for America" plan. It specifies adjusting rates for hospitals, providing fair compensation for drug manufacturing licenses, and ensuring healthcare providers accept these rates, while also allowing negotiation of drug prices to ensure affordability and access.

The section establishes a unified Medicare Trust Fund to receive funds from various sources, including taxes, premiums, and current program receipts, starting in fiscal year 2026. It specifies that the Trust Fund is exempt from certain federal restrictions on reproductive health services and includes rules for transferring funds from existing Medicare and Medicaid programs to support healthcare access, quality, and efficiency.

SEC. 2208 outlines the renaming of the Centers for Medicare & Medicaid Services to the Center for Health Care starting in 2027, describes the appeals process for Medicare coverage, and details individuals' rights to seek legal action if denied rights. It also emphasizes that no one should face discrimination in federally funded health programs and allows for the enforcement of existing civil rights protections, while regulating how healthcare providers interact with Medicare services.

The section outlines that, starting in 2036, states must make specific payments to the Medicare Trust Fund to stay eligible for certain federal health-related grants. These payments, known as "maintenance of effort" payments, will vary depending on the state's classification and will be adjusted annually based on economic growth.

The section explains that, unless otherwise specified, the Medicare for America program will follow certain rules and provisions that already apply to Medicare (referred to as title XVIII). This includes how benefits are covered and how service providers participate in the program, similar to existing Medicare regulations.

All individuals enrolled in Medicare for America will receive coverage for home and community-based long-term care services. This provision does not restrict access to other benefits, such as nursing facility benefits, that are covered under section 2203.

To qualify for long-term home- and community-based services, individuals must be eligible for Medicare for America and need substantial help with daily activities, like communication or self-care, as assessed by a health professional. This part ensures that people keep receiving needed services even if their condition improves temporarily, and stresses that services should focus on community living before considering institutional care. Benefits cover various supportive services, support caregiver compensation without replacing other federal benefits, and are administered by state entities, with regulations to prevent misuse.

For plan years starting in 2029, health insurance companies can offer individual market plans only if they have a contract with the Secretary. These plans are known as MA for America plans, which are a type of Medicare Advantage plan designed to provide benefits to individuals enrolled in Medicare for America.

The section describes how the existing rules for Medicare Advantage (MA) will mostly apply to a new program called MA for America. It specifies that the rules in place for Medicare Advantage, as of the date this new title was enacted, will be similarly applied to the MA for America sponsors, plans, and eligible participants unless specified otherwise.

The section explains that the payment rates for Medicare Advantage for America plans will be the same as those paid by Medicare for America. The Center for Healthcare's Administrator will pay these plans 95% of the average costs of Medicare for America in each county.

People who choose a Medicare Advantage for America plan might have to pay an extra monthly fee if the plan includes additional benefits or is more costly. This section makes it clear that individuals are allowed to select such plans and be responsible for the extra premium.

Medicare Advantage for America plans are required to pay no more for prescription drugs than the prices negotiated under the Medicare for America program.

Medicare Advantage for America plans are prohibited from paying fees to insurance brokers.

Such plans are not subject to the Medicare Secondary Payer (MSP) Requirement, meaning they can contribute to the payment of premiums and cost-sharing without any legal restriction.

In 2029, any mention of "Medicare Advantage" in laws and regulations will automatically refer to "Medicare Advantage for America."

The section outlines changes to federal health programs like Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP), specifying that certain benefits will not be available starting from future dates, while also ensuring that ongoing treatment as of those dates will continue. It states that other programs such as those for federal employees, TRICARE, veterans, and Native Americans are unaffected by these changes, and allows for eventual participation in Medicare for America. Additionally, the section announces the termination of state health exchanges by 2031 and affirms the separability of its provisions if parts are deemed invalid.

The section limits how and when Medicare Advantage (MA) organizations can remove providers or suppliers from their networks. Starting in 2026, MA organizations can only remove providers for specific reasons like medical negligence or legal violations. They must also have a fair notice and appeal process, ensure continuity of care for patients, and provide transparent information on how they manage their provider networks. Additionally, there are penalties for non-compliance, and updates to tools for comparing MA plans will be implemented.

The text outlines new network adequacy requirements for Medicare Advantage plans starting in 2024. These rules ensure that plans have enough accessible healthcare providers to meet patient needs, require annual certification of compliance, make average wait times and costs public, and give the Secretary authority to halt enrollments if there are too many violations.

The section eliminates the 24-month waiting period for Medicare coverage for individuals with disabilities, allowing them to access benefits immediately once they qualify. It involves several amendments to the Social Security Act to ensure that individuals no longer need to wait two years after becoming entitled to benefits, effective for services received after the law's enactment.

The section provides funding and instructions for the Secretary of Health and Human Services to ensure that all eligible individuals on State Medicaid waiting lists or waiver waiting lists are enrolled in Medicaid within 90 days of the law being passed.

A qualifying employer-sponsored health plan requires the employer to cover at least 70% of the premium and must include various benefits like vision, dental, and hearing. Larger employers must either offer such a plan or contribute 8% of their payroll to Medicare, and employees can choose to enroll in Medicare instead. The section also outlines non-discrimination rules and specifies the process for employer contributions, employee rights, and related regulations.

A new rule is being added to the Public Health Service Act that prohibits group health plans from requiring prior authorization or using step therapy protocols to limit treatments. This change will take effect with the first plan year after the subsection becomes law.

The amendment to Section 1861(i) of the Social Security Act states that individuals receiving Medicare outpatient observation services will be considered inpatients during that time. Their discharge date will be the day they stop receiving these services unless they are admitted as hospital inpatients when the observation period ends.

Federal funds are allowed to be used for abortion services as part of any health program or activity, regardless of other laws that might say otherwise.

Section 129 states that the mental health parity rules in the Public Health Service Act now apply to all health coverage, just like they already apply to health insurance companies and group health plans.

Beginning after the enactment of the act, health care providers who participate in Medicare for America may have 10% of their federal student loans canceled for each year of participation, provided they meet certain conditions, such as submitting an employment certification form. Additionally, any interest that accrues on the loan during the year it is partially canceled will also be eliminated.

The section clarifies that by 2026, health plans must include a definition of pediatric medical necessity, which covers medical care needed for children's growth and health issues. This definition will be reviewed and updated every two years by healthcare experts and stakeholders to ensure it aligns with the latest standards and evidence in pediatric healthcare.

The bill introduces requirements for hospitals to maintain specific minimum staffing levels of registered nurses to ensure safe and quality patient care. It includes guidelines for nurse-to-patient ratios, provisions for the rights and protections of nurses, and outlines the role of the Secretary of Health and Human Services in enforcing these standards, with hospitals required to develop, submit, and regularly update staffing plans based on these mandates.

The section outlines a requirement for hospitals to implement a staffing plan to ensure safe and quality healthcare by setting minimum nurse-to-patient ratios for different hospital units. This plan must be periodically evaluated and involve input from nurses, with measures in place to address factors like nurse competence and emergency situations, and must be submitted to the Secretary for review.

In this section, hospitals must post information about nurse-to-patient ratios and maintain records of staffing for at least three years, including nurse assignments and break times. These records must be accessible to the Secretary, nurses, and the public, while the Secretary is responsible for conducting audits to ensure compliance and accuracy.

Hospitals must follow minimum staffing rules for licensed practical nurses, which will be set within 18 months after this law is passed. The Secretary will base these rules on a study about nurse staffing's impact on patient care. These rules should be applied as soon as possible, or within two years in most areas, and within four years in rural hospitals.

Nurses have the right and duty to act based on their professional judgment and can refuse work assignments if they believe it compromises patient safety or violates regulations. Hospitals are prohibited from retaliating against nurses who refuse assignments or report issues, and they cannot interfere with nurses' rights to speak out or organize. Complaints about violations can be filed with the Secretary, who will investigate and protect those involved from retaliation.

The text outlines the enforcement procedures for the Secretary to handle violations by hospitals according to this title, including setting up complaint and investigation processes, requiring corrective action plans, and imposing civil money penalties on hospitals and individuals found in violation. Additionally, the Secretary must publicize penalties on a government website, with provisions for removing this information after a change in hospital ownership, and use collected penalties to carry out activities under this title.

The section outlines key definitions related to nursing, covering terms like "acuity level," which refers to how nurses assess patient needs, "competence," meaning how nurses apply their skills, and distinctions between different types of nurses like registered or practical nurses. It also defines concepts such as "nursing care plan," which details the care given to patients, and "state of emergency," focusing on health-related emergencies that demand immediate attention.

The section clarifies that nothing in the specified title allows for the sharing of private patient information unless permitted or required by other laws.

The section amends the Patient Protection and Affordable Care Act to increase cost-sharing reductions for health plans, raising the plan's coverage to 95% for those earning between 100% and 200% of the poverty line, 90% for those earning between 200% and 300%, and 85% for those earning between 300% and 400%. These changes will apply from 2026, and the funding for these increased benefits will be provided by the federal government.

The section repeals the part of the Social Security Act that allowed for bonus payments to Medicare Advantage plans.

All parts and changes of Public Law 115-97 will stop being effective for calendar, taxable, plan, or limitation years starting after December 31, 2026. From that point, the Internal Revenue Code of 1986 will be used as though these provisions and changes had never been made.

A 5 percent tax is applied to the portion of a taxpayer's adjusted gross income that exceeds $500,000.

The section modifies the Internal Revenue Code to clarify that the basis of property acquired from a deceased person should be the same as it was in the hands of the deceased. This change applies to properties acquired after the enactment date of the Act.

The section changes the Medicare payroll tax rate in the Internal Revenue Code from 0.9 percent to 4 percent and states that this change will apply to taxable years starting after the law is enacted.

The section changes the Net Investment Income Tax rate from 3.8% to 6.9% as per the Internal Revenue Code of 1986. This change applies to taxable years starting after the law is enacted.

The section states that starting January 1, 2024, people will no longer be able to deduct contributions made to health savings accounts for tax purposes, as the monthly limit for these deductions will be set to zero.

The bill proposes increasing the excise taxes on various tobacco products, including small cigars, cigarettes, pipe tobacco, roll-your-own tobacco, large cigars, and smokeless tobacco. Additionally, it introduces a tax on smokeless tobacco sold in discrete single-use units and defines these units within the legislation.

The section outlines changes to excise taxes on alcohol. It increases the tax rate for distilled spirits, wine, and beer to $16.00 per proof gallon by amending various sections of the Internal Revenue Code of 1986.

The section introduces a tax on sugary drinks, where manufacturers, producers, or importers must pay one cent for every 4.2 grams of caloric sweetener in these beverages. Certain drinks, like milk substitutes and juice, are exempt from this tax, and sweeteners that have already been taxed are not taxed again if used in other sweetened drinks.

The section imposes a tax on the sale or transfer of sugar-sweetened beverages, calculated at a rate of one cent for every 4.2 grams of sugar. This tax is to be paid by the manufacturer, producer, or importer of the beverage.

In this section, the bill defines what counts as a "specified sugar-sweetened beverage product" by describing any liquid with added caloric sweeteners intended for human consumption, but it excludes drinks primarily based on milk, fruit juice, infant formula, certain medical liquids, and products taxed like alcoholic drinks. "Caloric sweetener" refers to sugars like monosaccharides, disaccharides, and high-fructose corn syrup.

In Section 4173, it explains that a sugary drink will not be taxed again for sweeteners it already paid taxes on if those sweeteners were part of another sugary drink used to make it. Additionally, starting from sales after December 31, 2015, the tax amount will increase with inflation, using 2014 as the base year for calculations, and will be rounded to the nearest one-tenth of a cent.

The section repeals a specific tax related to expensive employer-sponsored health insurance plans by removing Section 4980I from the Internal Revenue Code. It also modifies existing laws to redefine what counts as "applicable employer-sponsored coverage," including coverage paid by both employers and employees, and clarifies the way costs are calculated, with changes taking effect from January 2027.

The section establishes the Prescription Drug and Medical Device Price Review Board within the Department of Health and Human Services. This Board is tasked with reviewing the prices of prescription drugs and medical devices.

The section outlines the composition and responsibilities of a Board including high-level officials from various government departments. It also details rules for appointing a chairperson, a director, and additional staff, sets pay limits, and specifies that banned individuals such as former drug company lobbyists and executives from companies under federal enforcement cannot be employed.

The text prohibits manufacturers from charging excessive prices for prescription drugs and medical devices, based on a formula determined by a regulatory board. The board can penalize manufacturers for violations, and any person can petition the board to evaluate drug pricing, but certain value assessment methods like Quality-Adjusted Life Years are not allowed.

If a company that holds a patent for a prescription drug or medical device charges too much for it, the Board can shorten the patent term by up to 5 years or impose a civil penalty up to 10% of the company's sales. Additionally, a new tax may be applied to the excess profits if these high prices continue, starting from sales after December 31, 2025.

There is a tax applied to the sale of prescription drugs and medical devices when the selling price is higher than a reasonable price set by a special review board. This applies to all products intended for human use, as defined in specific sections of existing health-related laws.

The section discusses the issue of high prices for prescription drugs and medical devices, likely addressing measures or considerations to manage these excessive costs.

The section outlines various powers and responsibilities of the Board, including obtaining information from federal agencies, using mail services, securing administrative support, and contracting for services. It also grants the Board authority to conduct investigations, issue subpoenas, enforce court orders, and protect confidential information according to existing laws.

The Board must create final regulations to implement this Act within one year of their first meeting. These regulations need to follow the notice and comment procedures outlined in U.S. law.

The Board is required to submit a yearly report to federal agencies that provide prescription drugs or medical devices, listing any items sold at excessive prices. This report, which is based on the Board's findings from the previous year, must be made available to the public.

In this section, several terms are defined: an "affiliate" is an entity connected through control to a manufacturer; the "average manufacturer price" is the yearly average price for a drug or medical device in the U.S.; a "medical device" aligns with existing federal definitions; a "prescription drug" is defined by federal law, needing a doctor's approval for use; a "manufacturer" is the holder of a drug approval or the entity that sets its price; and the "wholesale acquisition cost" follows its definition under the Social Security Act.

The section introduces a new rule in the Federal Food, Drug, and Cosmetic Act that stops drug companies from advertising their drugs directly to consumers for the first three years after the drug is approved, but this can be waived by the Secretary if they believe the advertising would benefit public health. After these three years, the Secretary can still stop such advertising if the drug is found to have serious health risks.

In SEC. 506J, it is stated that for the first three years after a drug's approval, there is a prohibition on direct-to-consumer advertising unless a waiver is granted by the Secretary for the third year if it benefits public health. After this period, the Secretary may continue to restrict advertising if significant health risks are identified, and changes in regulations will be made to ensure compliance with this section.

The section adds a requirement for drug manufacturers to report to the Secretary of Health and Human Services any significant price increases for certain drugs. The report must include detailed information on the drug's pricing history, development costs, revenues, and other financial data, with civil penalties for non-compliance. The Secretary is required to make the reports public while protecting trade secrets and to submit an annual summary to Congress.

In this section, drug manufacturers are required to report to the Secretary if they plan to increase the price of certain drugs by specified percentages. The report must include details such as the justification for the price increase, the drug’s price history, manufacturing costs, and other financial information. If a manufacturer fails to submit a report, they may face fines. Additionally, the Secretary will publicly post these reports, but will keep trade secrets and confidential information protected.

The Secretary is authorized to collect fines from violations under section 399OO and use the money, along with other available funds, to support activities in this part of the law and enhance information for consumers and providers about drug value and price transparency.

The section requires the Secretary of Health and Human Services to submit an annual report to Congress and publish it online. The report must summarize data and include economic analyses, while protecting any trade secrets and confidential information as required by law.

Congress expresses that it believes "Medicare for America" will greatly benefit the health of people in the U.S. and improve the factors that affect the health of those who are part of the program.

The bill mandates that within two years of its enactment, the Secretary of Health and Human Services will analyze health data, ensuring privacy, to understand its impact on public health. It requires the CDC and NIH to study how different factors like race, socioeconomic status, and health status affect individuals' coverage. Every ten years, the Secretary will report to Congress on the Act's impact based on these studies.