Representative DeLauro’s ‘Medicare for America Act’: Details and Prospects

Representative Rosa DeLauro, a Democrat from Connecticut, has proposed the Medicare for America Act. This legislation would expand Medicare access to all U.S. residents while allowing individuals to keep employer-sponsored insurance if they choose.

Key Provisions of the Proposal

The proposal eliminates deductibles and caps premiums at 8% of income. It limits annual out-of-pocket expenses to $3,500 for individuals and $5,000 for households. Currently, the measure has no cosponsors and faces a challenging path through the Republican-controlled Congress.

According to the U.S. Census Bureau, about 26.7 million Americans were uninsured in 2025. Employment-based insurance covered 53.5% of the population at some point during the year. The expiration of Affordable Care Act subsidies led to increased marketplace costs. KFF estimates indicate average annual premiums for subsidized marketplace enrollees will rise from $888 in 2025 to $1,904 in 2026, a 114% increase.

Structure of the Medicare for America Act

The plan focuses on choice. All U.S. residents would become eligible for Medicare for America. Uninsured individuals would be automatically enrolled. Employees with employer-provided insurance could choose to remain with that coverage or opt for Medicare for America. If an employee chooses the latter, employers must contribute to premiums.

Employers could also offer Medicare for America to cover workers. Private employer plans would need to meet higher standards, including coverage for dental, vision, and hearing services. This aspect differentiates it from Representative Pramila Jayapal’s Medicare for All Act, which seeks to establish a national program without duplicative coverage.

Cost and Coverage Details

The act plans to have no deductible and caps premiums at 8% of household income. Those earning below 200% of the federal poverty level would not pay premiums or out-of-pocket costs. Annual expenses would be capped at $3,500 for individuals and $5,000 for households, with lower limits for families earning below 600% of the poverty level.

The range of coverage includes dental, vision, hearing services, prescription medications, maternity and reproductive care, mental health, and long-term services. Preventive and emergency care, chronic disease management, and child care under 21 would face no cost-sharing. The proposal would also eliminate prior authorization, step therapy, and the 24-month Medicare waiting period for disabilities.

Strategies for Cost Control

The legislation aims to alter health care pricing. Providers must accept Medicare for America rates from employer and Medicare Advantage plans. Payments for primary care and mental health services would rise by at least 30%. The plan introduces site-neutral payments and aims to reduce Medicare Advantage overpayments. Drug pricing would undergo negotiation, with competitive licensing if manufacturers reject fair pricing.

Funding the Plan

The plan’s funding involves repealing the One Big Beautiful Bill Act, which had significant spending cuts, and introducing new taxes on high earners, including a 5% surtax on income above $500,000. DeLauro emphasized the aim is to ensure coverage while preserving existing choices.

If you like your current employer coverage, you keep it. If you want Medicare, it is yours, she stated when announcing the bill.

Legislative Challenges and Outlook

The proposal faces significant political hurdles. Introduced as H.R. 10924 on October 29, it was sent to six House committees, including Ways and Means and Energy and Commerce. DeLauro remains its sole sponsor, with no cosponsors. Currently, Republicans control both chambers of Congress, making passage unlikely unless bipartisan support emerges.

There is notable Democratic support for another proposal, Jayapal’s Medicare for All Act, H.R. 3069, which has 118 Democratic cosponsors. Other health-related proposals include the bipartisan INSULIN Act of 2026, designed to cap insulin costs, and a bill introduced to lower Medicare eligibility to age 50.