H.R. 9054: Earned Benefits Equality and Family Reunification Act

This proposed legislation, known as the Earned Benefits Equality and Family Reunification Act, aims to establish a 10-year demonstration program under Medicare that would allow eligible beneficiaries to use their Medicare benefits for health care services received in selected foreign countries. The key elements of the bill are outlined below:

1. Program Implementation

The Secretary of Health and Human Services is required to set up this demonstration program within one year of the bill's enactment. The program will permit qualifying beneficiaries to apply their Medicare benefits towards health care services and insurance costs in other countries.

2. Objectives of the Program

The program is designed with specific goals in mind, which include:

• Increasing the quality of health care for participating beneficiaries.
• Reducing government health care costs associated with these beneficiaries.
• Facilitating family reunification for participants.
• Alleviating pressure on the U.S. medical infrastructure.

3. Program Design and Stakeholder Input

The Secretary will design the program based on input from various stakeholders, including representatives from:

• The U.S. Department of State
• Health care experts
• Medicare beneficiaries
• Experts on foreign health insurance systems

Guidelines will be developed to ensure quality of care and to primarily focus on low-income participants.

4. Selected Countries

The initial selection of countries where beneficiaries can use their Medicare benefits will include at least 11 nations, such as:

• Canada
• Germany
• India
• Israel
• South Korea
• The Philippines
• Panama
• Mexico
• The Dominican Republic
• Ghana

5. Participation and Eligibility

Participation in the program is voluntary, and beneficiaries may opt out at any time. To qualify for the program, beneficiaries must be residents of either the U.S. or the selected countries. A cap of at least 150,000 participants may be established.

6. Payments and Financial Arrangements

Payments will be made to or on behalf of beneficiaries for their health care expenses in the foreign countries, covering a range of costs including health insurance premiums. However, these payments will be limited to ensure they do not exceed what would have been spent for equivalent services in the U.S.

7. Medicare Advantage Involvement

The program may be administered in part or in full through Medicare Advantage organizations, with measures in place to consider such payments equivalent to traditional Medicare benefits for certain regulatory purposes.

8. Oversight and Accountability

The Secretary will conduct annual evaluations of the program to assess its effectiveness and compliance with its stated goals, with the inclusion of strategies to report waste, fraud, and abuse.

9. Funding

The program will be funded through existing Medicare funds, particularly from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund.

10. Waivers and Limitations

The Secretary has the authority to waive certain provisions as necessary to effectively administer the program. Furthermore, there are restrictions on judicial review regarding selection processes for participating organizations and sites.

Relevant Companies

• CAH - Cardinal Health Inc.: As a distributor of medical supplies and pharmaceuticals, Cardinal Health may see shifts in demand based on adjustments in health care consumption patterns due to this program.
• UNH - UnitedHealth Group Incorporated: This health insurance company could be affected as it may need to adapt its offerings and services in response to the expanded use of Medicare benefits abroad.
• HUM - Humana Inc.: As a major player in the Medicare Advantage space, Humana could experience changes in its enrollment and service delivery models due to the introduction of this demonstration program.