119-hr4093

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4093 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 4093

 To amend title XVIII of the Social Security Act to require the 
 Secretary of Health and Human Services to publish information on 
 expenditures under the Medicare program, and for other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 June 24, 2025

 Mr. Bean of Florida (for himself and Mr. Hern of Oklahoma) introduced 
 the following bill; which was referred to the Committee on Ways and 
 Means, and in addition to the Committee on Energy and Commerce, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
 committee concerned

_______________________________________________________________________

 A BILL

 To amend title XVIII of the Social Security Act to require the 
 Secretary of Health and Human Services to publish information on 
 expenditures 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 ``Apples to Apples Comparison Act of 
2025''.

SEC. 2. REQUIRING THE SECRETARY OF HEALTH AND HUMAN SERVICES TO PUBLISH 
 INFORMATION ON EXPENDITURES UNDER THE MEDICARE PROGRAM.

 

Section 1874 of the Social Security Act (42 U.S.C. 1395kk) is 
amended--

    (1) in subsection

    (g) --
        (A) in paragraph

    (1) --
            (i) in the matter preceding subparagraph
        (A) , by inserting ``(and, beginning with 2025, 
 publish on the public website of the Centers 
 for Medicare & Medicaid Services in machine-
 readable files information on)'' after ``a 
 report on'';
            (ii) in subparagraph
        (A) , by inserting 
 ``(and, beginning with 2025, by county and 
 Metropolitan Statistical Area)'' after 
 ``State''; and
            (iii) in subparagraph
        (B) --
            (I) in clause
            (ii) , by striking 
 ``and'' at the end;
            (II) in clause
            (iii) , by striking 
 the period and inserting ``; and''; and
            (III) by adding at the end the 
 following new clause:
 ``
            (iv) beginning with 2025, each category 
 of individuals described in subsection

    (h)

    (1) .''; and
        (B) by adding at the end the following new 
 paragraph:
 ``

    (3) Special rule for 2025 report and publication of 
 information.--As part of the report and publication of 
 information required under paragraph

    (1) for 2025, the 
 Secretary shall include enrollment information submitted under 
 this subsection for each preceding year (beginning with 2015), 
 broken down by county and Metropolitan Statistical Area and 
 provided for each category of individuals described in 
 subsection

    (h)

    (1) .''; and

    (2) by adding at the end the following new subsection:
 ``

    (h) Information on Expenditures.--
 ``

    (1) In general.--Not later than 30 days after the last 
 day of each year (beginning with 2025), the Secretary shall, 
 for each county and each Metropolitan Statistical Area, publish 
 on the public website of the Centers for Medicare & Medicaid 
 Services in machine-readable files the total and average 
 expenditures under this title for items and services furnished 
 to individuals entitled to benefits under part A or enrolled 
 under part B residing in such county or Metropolitan 
 Statistical Area for each month occurring in the specified 
 historical period and for each month occurring in the specified 
 projected period with respect to such year, broken down by the 
 following categories of individuals:
 ``
        (A) Individuals entitled to benefits under part A 
 and not enrolled under part B.
 ``
        (B) Individuals who are--
 ``
            (i) not entitled to benefits under part 
 A;
 ``
            (ii) enrolled under part B; and
 ``
            (iii) not enrolled under a Medicare 
 Advantage plan under part C.
 ``
            (C) Individuals who are--
 ``
            (i) entitled to benefits under part A and 
 enrolled under part B; and
 ``
            (ii) not enrolled under a Medicare 
 Advantage plan under part C.
 ``
            (D) Individuals described in subparagraph
        (A) who 
 are enrolled in a prescription drug plan under part D.
 ``
        (E) Individuals described in subparagraph
        (B) who 
 are enrolled in a prescription drug plan under part D.
 ``
        (F) Individuals described in subparagraph
            (C) who 
 are enrolled in a prescription drug plan under part D.
 ``
        (G) Individuals described in subparagraph
        (A) who 
 are not enrolled in a prescription drug plan under part 
 D.
 ``
        (H) Individuals described in subparagraph
        (B) who 
 are not enrolled in a prescription drug plan under part 
 D.
 ``
            (I) Individuals described in subparagraph
            (C) who 
 are not enrolled in a prescription drug plan under part 
 D.
 ``
        (J) Individuals described in subparagraph
        (A) who 
 are enrolled in a Federal health care program (as 
 defined in 

section 1128B) or a health plan under 
 chapter 89 of title 5, United States Code.
 ``
        (K) Individuals described in subparagraph
        (B) who 
 are enrolled in such a program or plan.
 ``
            (L) Individuals described in subparagraph
            (C) who 
 are enrolled in such a program or plan.
 ``
            (M) Individuals described in subparagraph
        (A) who 
 are not enrolled in such a program or plan.
 ``
        (N) Individuals described in subparagraph
        (B) who 
 are not enrolled in such a program or plan.
 ``
        (O) Individuals described in subparagraph
            (C) who 
 are not enrolled in such a program or plan.
 ``
        (P) Individuals described in subparagraph
        (A) who 
 are enrolled in a group health plan (as defined in 
 

section 2791 of the Public Health Service Act) or a 
 medicare supplemental policy under 

section 1882.
 ``
        (Q) Individuals described in subparagraph
        (B) who 
 are enrolled in such a plan or policy.
 ``
        (R) Individuals described in subparagraph
            (C) who 
 are enrolled in such a plan or policy.
 ``
        (S) Individuals described in subparagraph
        (A) who 
 are not enrolled in such a plan or policy.
 ``
        (T) Individuals described in subparagraph
        (B) who 
 are not enrolled in such a plan or policy.
 ``
        (U) Individuals described in subparagraph
            (C) who 
 are not enrolled in such a plan or policy.
 ``
            (V) Individuals enrolled in a specialized MA plan 
 for special needs individuals, broken down by each type 
 of plan.
 ``
        (W) Individuals enrolled in an MA plan other than 
 a plan described in subparagraph
            (V) .
 ``
            (X) Individuals enrolled in an MA plan.
 ``
        (Y) Individuals described in subparagraph
            (X) who 
 are enrolled in a Federal health care program (as 
 defined in 

section 1128B) or a health plan under 
 chapter 89 of title 5, United States Code.
 ``
        (Z) Individuals described in subparagraph
            (X) who 
 are not enrolled in such a program or plan.
 ``

    (AA) Individuals described in subparagraph
            (X) who are enrolled in a group health plan (as defined in 
 

section 2791 of the Public Health Service Act) or a 
 medicare supplemental policy under 

section 1882.
 ``

    (BB) Individuals described in subparagraph
            (X) who are not enrolled in such a plan or policy.
 ``
            (CC) Individuals described in subparagraph
            (X) who are enrolled in a prescription drug plan under part 
 D.
 ``
            (DD) Individuals described in subparagraph
            (X) who are not enrolled in such a plan.
 ``

    (EE) Individuals described in subparagraph
            (X) who are enrolled in an MA-PD plan.
 ``

    (FF) Individuals described in subparagraph
            (X) who are not enrolled in such a plan.
 ``

    (GG) Individuals described in subparagraph
            (CC) or

    (EE) who are enrolled in a Federal health care 
 program (as defined in 

section 1128B) or a health plan 
 under chapter 89 of title 5, United States Code.
 ``

    (HH) Individuals described in subparagraph
            (CC) or

    (EE) who are not enrolled in such a program or plan.
 ``
            (II) Individuals enrolled in an employer group 
 waiver plan.
 ``

    (2) === Definitions. ===
-For purposes of this subsection:
 ``
        (A) Specified historical period.--The term 
 `specified historical period' means, with respect to a 
 year, the 10-year period ending on the last day of such 
 year.
 ``
        (B) Specified projected period.--The term 
 `specified projected period' means, with respect to a 
 year, the period beginning on the first day of the 
 subsequent year of a duration specified by the 
 Secretary (but in no case to exceed a duration of 5 
 years).''.

SEC. 3. MEDPAC ANALYSIS OF MEDICARE ADVANTAGE AND FEE-FOR-SERVICE 
 EXPENDITURES.

 

Section 1805

    (b) of the Social Security Act (42 U.S.C. 1395b-6

    (b) ) 
is amended by adding at the end the following new paragraph:
 ``

    (12) Analysis of medicare advantage and fee-for-service 
 expenditures.--
 ``
        (A) In general.--The Commission shall, as part of 
 the report described in paragraph

    (1)
            (C) submitted for 
 each year (beginning with 2026), include a 
 retrospective analysis of average expenditures under 
 this title for individuals enrolled in a Medicare 
 Advantage plan under part C compared to average 
 expenditures under this title for individuals entitled 
 to benefits under part A and enrolled under part B who 
 are eligible to enroll under such a plan but who are 
 not so enrolled.
 ``
        (B) Considerations.--In preparing each analysis 
 described in subparagraph
        (A) , the Commission shall--
 ``
            (i) use data provided by the Chief 
 Actuary of the Centers for Medicare & Medicaid 
 Services and the Boards of Trustees of the 
 Federal Hospital Insurance Trust Fund 
 established under 

section 1817 and the Federal 
 Supplementary Medical Insurance Trust fund 
 established under 

section 1841 and such other 
 data as the Commission determines appropriate;
 ``
            (ii) take into account--
 ``
            (I) differences in value provided 
 under Medicare Advantage plans compared 
 to the value provided under parts A and 
 B, such as the existence of out-of-
 pocket expenditure caps, supplemental 
 benefits available under such plans, 
 and the integration of benefits for 
 covered part D drugs under certain such 
 plans; and
 ``
            (II) demographic differences of 
 individuals enrolled in Medicare 
 Advantage plans compared to individuals 
 entitled to benefits under part A and 
 enrolled under part B who are not 
 enrolled in such a plan; and
 ``
            (iii) take into account differences in 
 HCC risk scores but not take into account any 
 favorable selection differences with respect to 
 enrollment in such plans.
 ``
            (C) Publication requirements.--With respect to 
 each analysis described in subparagraph
        (A) , the 
 Commission shall--
 ``
            (i) make public all data used in 
 preparing such analysis in a manner that--
 ``
            (I) allows replication of such 
 analysis; and
 ``
            (II) protects the confidentiality 
 of personal information of individuals 
 entitled to benefits under part A and 
 enrolled under part B;
 ``
            (ii) not later than 60 days prior to the 
 submission of such analysis, make public the 
 methodology used to conduct such analysis and 
 allow at least 30 days for public comment on 
 such methodology; and
 ``
            (iii) make public a response to each such 
 comment received on the methodology prior to or 
 concurrent with the submission of such 
 analysis.''.

SEC. 4. TRUSTEES REPORT OF EXPENDITURE INFORMATION.

 

Section 1874 of the Social Security Act (42 U.S.C. 1395kk), as 
amended by 

section 2, is further amended by adding at the end the 
following new subsection:
 ``
            (i) Trustees' Report of Expenditure Information.--
 ``

    (1) In general.--The Boards of Trustees of the Federal 
 Hospital Insurance Trust Fund established under 

section 1817 
 and the Federal Supplementary Medical Insurance Trust Fund 
 established under 

section 1841 shall jointly, as part of the 
 reports described in sections 1817

    (b)

    (2) and 1841

    (b)

    (2) submitted for a year (beginning with 2026), include information 
 on aggregate and average expenditures under this title for the 
 following categories of individuals, broken down, in the case 
 of the category described in subparagraph
            (C) , by expenditures 
 under part A and expenditures under part B:
 ``
        (A) Individuals entitled to benefits under part A 
 and not enrolled under part B.
 ``
        (B) Individuals enrolled under part B and not 
 entitled to benefits under part A.
 ``
            (C) Individuals entitled to benefits under part 
 A, enrolled under part B, and not enrolled in a 
 Medicare Advantage plan under part C.
 ``

    (2) Provision of disaggregated information.--The Boards 
 of Trustees described in paragraph

    (1) shall, as part of all 
 expenditure data (including data tables) made public by such 
 Boards, disaggregate such data, to the extent practicable, 
 based on the categories of individuals described in paragraph

    (1) .''.
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