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HR 1777 SC

102d CONGRESS

1st Session

H. R. 1777

To amend title XVIII of the Social Security Act to provide for coverage of the general population under the medicare program, and for other
purposes.

IN THE HOUSE OF REPRESENTATIVES

APRIL 16, 1991

Mr. GIBBONS introduced the following bill; which was referred jointly to the Committees on Ways and Means and Energy and Commerce

October 25, 1991

Additional sponsors: Mr. STARK, Mr. BUSTAMANTE, Mr. PETERSON of Florida, Mr. LEWIS of Georgia, Ms. NORTON, and Mr. Scheuer

A BILL

To amend title XVIII of the Social Security Act to provide for coverage of the general population under the medicare program, and for other
purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Medicare Universal Coverage Expansion Act of 1991'.

SEC. 2. COVERAGE OF GENERAL POPULATION UNDER MEDICARE PROGRAM.

(a) IN GENERAL- Section 226 of the Social Security Act (42 U.S.C. 426) is amended to read as follows:

`ENTITLEMENT TO HOSPITAL INSURANCE BENEFITS AND SUPPLEMENTARY

MEDICAL INSURANCE BENEFITS
`SEC. 226. Every individual who is a citizen or national of the United States or who is an alien lawfully admitted for permanent
residence or otherwise lawfully residing permanently in the United States under color of law is entitled to hospital insurance benefits
under part A of title XVIII and to supplementary medical insurance benefits under part B of such title, beginning with January 1,
1993.'.

(b) PART B- Section 1836 of such Act (42 U.S.C. 1395o) is amended by striking all that follows `who' and inserting the following: `is
entitled to hospital insurance benefits under part A for a month is entitled to benefits under the insurance program established by this
part in the month.'.

(c) MEDICARE AS PRIMARY PAYOR- Section 1862 of such Act (42 U.S.C. 1395y) is amended by striking subsection (b).

(d) MISCELLANEOUS CONFORMING AMENDMENTS- Sections 226A, 1818, 1818A, 1837, 1838, and 1843 of such Act are repealed.

SEC. 3. EXPANSION OF PREVENTIVE HEALTH CARE BENEFITS.

Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)) is amended--

(1) in paragraph (1)(B), by inserting `pregnancy-related services, pre-natal, post-natal, and well-child care, and other
preventive health services determined by the Secretary to be reasonable with respect to pregnancy and newborns or for the
prevention of illness,' after `1861(s)(10),', and

(2) in paragraph (7), by inserting `(except as otherwise allowed under paragraph (1)(B))' after `physical checkups'.

SEC. 4. FINANCING.

(a) ELIMINATION OF PREMIUMS- Section 1839 of the Social Security Act (42 U.S.C. 1395r) is repealed.

(b) APPROPRIATIONS- Section 1844(a) of such Act (42 U.S.C. 1395w(a)) is amended by striking all that follows `Trust Fund' the first
place it appears and inserting the following: `a Governmental contribution equal to aggregate actuarial value of the benefits payable
under this part for all individuals.'.

(c) MODIFICATIONS TO HOSPITAL INSURANCE PAYROLL TAX-

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(1) EXTENSION OF TAX TO ALL WAGES- Paragraph (2) of section 3121(x) of the Internal Revenue Code of 1986 (relating to
applicable contribution base) is amended--

(A) in subparagraph (B), by striking `any calendar year after 1991' and inserting `calendar year 1992', and

(B) by striking `and' at the end of subparagraph (A), by striking the period at the end of subparagraph (B) and inserting `,
and', and by adding at the end the following new subparagraph:

`(C) for any calendar year after 1992, an unlimited amount.'

(2) INCREASE IN RATE OF TAX-

(A) IN GENERAL- Subchapter C of chapter 21 of such Code (relating to FICA general provisions) is amended by
redesignating section 3128 as section 3129, and by inserting after section 3127 the following new section:

`SEC. 3128. ANNUAL DETERMINATION OF APPLICABLE RATE OF HOSPITAL INSURANCE TAX.

`(a) IN GENERAL- Not later than December 15 of 1992 and each calendar year thereafter, the Secretary shall prescribe the rates of
tax which shall apply under sections 3101(b), 3111(b), and 1401(b) with respect to the succeeding calendar year.

`(b) AMOUNT OF INCREASE- Subject to subsections (c) and (d), the rates of tax to apply with respect to any calendar year shall be
prescribed under subsection (a) at levels determined by the Secretary to be sufficiently above the rates applicable with respect to
1992 to increase Federal revenues during the calendar year by an aggregate amount equal to--

`(1) the amount of the reduction in Federal revenues which the Secretary estimates will occur during the calendar year as a
result of the amendments made by the Medicare Universal Coverage Expansion Act of 1991 (other than section 4(c)(2) of such
Act), plus

`(2) a reserve amount which does not exceed 10 percent of the amount described in paragraph (1).

`(c) ADJUSTMENTS- The Secretary shall make adjustments in the rates determined under subsection (b) for any calendar year to the
extent that the estimate made under paragraph (1) of such subsection for the preceding calendar year was in excess of or less than
the amount of the reduction described in such paragraph which occurred during such preceding calendar year.

`(d) PROPORTIONALITY OF RATES- With respect to any calendar year for which rates are prescribed under this section--

`(1) the rate applicable under section 3101(b) shall be equal to the rate applicable under section 3111(b), and

`(2) the rate applicable under section 1401(b) shall be equal to the sum of the rates applicable under sections 3101(b) and
3111(b).'

(B) CONFORMING AMENDMENTS TO TAX RATE TABLES-

(i) TAX ON EMPLOYEES- Subsection (b) of section 3101 of such Code (relating to rate of hospital insurance tax on
employees) is amended by striking paragraphs (1) through (6) and inserting the following:

`In cases of wages

--The rate

received during:

--shall be:

1991 or 1992

--1.45 percent

1993 or thereafter

--the percentage

--prescribed under

--section 3128.'

(ii) TAX ON EMPLOYERS- Subsection (b) of section 3111 of such Code (relating to rate of hospital insurance tax on
employers) is amended by striking paragraphs (1) through (6) and inserting the following:

`In cases of wages

--The rate

paid during:

--shall be:

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1991 or 1992

--1.45 percent

1993 or thereafter

--the percentage

--prescribed under

--section 3128.'

(iii) TAX ON SELF-EMPLOYED- Subsection (b) of section 1401 of such Code (relating to rate of hospital insurance tax on
self-employment income) is amended by striking the item beginning with `December 31, 1985' and inserting the
following:
-----------------------------------------------------------------------------------

-----------------------------------------------------------------------------------

`December 31, 1985 January 1, 1993 2.90

December 31, 1992 the percentage prescribed under section 3128.'

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(C) CLERICAL AMENDMENT- The table of sections for subchapter C of chapter 21 of such Code is amended by striking the
item relating to section 3128 and inserting the following:

`Sec. 3128. Annual determination of applicable rate of hospital insurance tax.

`Sec. 3129. Short title.'

(3) EFFECTIVE DATE- The amendments made by this subsection shall apply with respect to remuneration paid after December
31, 1992, and with respect to earnings from self-employment attributable to taxable years beginning after such date.

(d) APPLICATION OF SURPLUS IN OASI TRUST FUND- There are hereby transferred from the Federal Old-Age and Survivors Insurance
Trust Fund to the Federal Hospital Insurance Trust Fund such amounts as the Secretary determines not to be needed in the current or
succeeding fiscal year for expenses of the Federal Old-Age and Survivors Insurance Trust Fund.

(e) TRANSFER OF AMOUNTS FROM FEDERAL HOSPITAL INSURANCE TRUST FUND- Section 1817(a) of the Social Security Act (42
U.S.C. 1395i(a)) is amended by adding at the end the following new sentence: `There shall be transferred periodically from the Trust
Fund to the Medicare Supplementary Medical Insurance Trust Fund such amounts as may be expended under the latter Fund as are
attributable to the amendments made by the Medicare Universal Coverage Expansion Act of 1991.'.

SEC. 5. EFFECTIVE DATES.

Except as otherwise specifically provided in this Act, this Act, and the amendments made by this Act, shall first be effective on
January 1, 1993, for services furnished on or after such date.

END

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