Introduction of Medicare for America Act
Representative Rosa DeLauro, a Connecticut Democrat, has put forth the ‘Medicare for America Act.’ This initiative aims to expand Medicare, offering it to all U.S. residents while allowing individuals to maintain qualifying employer-sponsored insurance.
The proposal seeks to eliminate deductibles and cap premiums at 8% of income. It also sets limits on annual out-of-pocket spending: $3,500 for individuals and $5,000 for households.
As of now, the measure lacks cosponsors and faces the challenge of advancing through a Republican-controlled Congress.
Insurance Landscape
The United States Census Bureau reported approximately 26.7 million Americans, or 7.9%, were uninsured in 2025. Employment-based insurance remains the most common coverage method, accounting for 53.5% of the population’s insurance during the year.
The expiration of enhanced Affordable Care Act subsidies has escalated costs for marketplace customers, with the KFF estimating an average annual premium increase of 114% for subsidized enrollees from 2025 to 2026.
Plan Details and Choices
In contrast to a single-payer system, DeLauro’s proposal emphasizes choice. All U.S. residents would be eligible for Medicare for America, with an automatic enrollment provision for uninsured individuals. Those with employer insurance can choose to remain with it or opt for the Medicare program. Employers would be required to contribute to premiums if an employee selects Medicare for America.
Existing private employer plans would need to meet stricter criteria, including offering dental, vision, and hearing benefits. This distinguishes it from Representative Pramila Jayapal’s Medicare for All Act.
Patient Costs and Coverage
Medicare for America proposes no deductibles and caps premiums at 8% of household income. Individuals earning under 200% of the federal poverty level would not pay premiums or out-of-pocket costs. The plan limits annual out-of-pocket expenses to $3,500 for an individual and $5,000 for a household. Smaller limits apply to families earning below 600% of the poverty level.
Coverage includes dental, vision, hearing services, prescription drugs, maternity and reproductive care, among other areas. Cost sharing is eliminated for preventive and emergency care, chronic disease management, and care for children under 21. The proposal also prohibits prior authorization, step therapy, and removes the 24-month Medicare waiting period for disabilities.
Cost Control Measures
The legislation focuses on reforming healthcare pricing. Providers would need to accept Medicare for America rates from employer and Medicare Advantage plans under an all-payer rate-setting system. Payments for primary care and mental-health services would increase by at least 30%, alongside introducing site-neutral payments and addressing Medicare Advantage overpayments.
Drug pricing would undergo changes, requiring the health secretary to negotiate medicine prices, with competitive licensing available if manufacturers decline the proposed fair price.
Funding the Medicare for America Act
Funding the act would involve repealing the One Big Beautiful Bill Act and introducing new taxes on high-income earners, including a 5% surtax on income above $500,000. The aim is to ensure coverage while preserving existing healthcare choices.
“If you like your current employer coverage, you keep it,” DeLauro stated. “If you want Medicare, it is yours.”
Legislative Challenges
Currently, the proposal faces significant political hurdles. H.R. 10924 was introduced on October 29 and referred to multiple House committees, without additional sponsors. The Republican-controlled Congress presents a challenge to the advancement of the Democratic initiative.
DeLauro’s proposal contrasts with Jayapal’s Medicare for All Act, which has broader Democratic support with 118 cosponsors. Other active health proposals include the bipartisan INSULIN Act of 2026 and a measure to lower Medicare eligibility to 50.
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