“To amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes.”
No CRS summary available for this bill.
This section amends the definition of qualified health plan (QHP) under the Affordable Care Act (ACA) to explicitly include the public health insurance option established under new ACA section 1314 and directs the Secretary of Health and Human Services (HHS) to establish and offer such option exclusively through ACA Exchanges for plan years beginning on or after January 1, 2027. The public option, which must offer bronze, silver, and gold plans and comply with all QHP requirements (including essential health benefits, consumer protections, and cost-sharing), is designed to provide affordable, high-quality coverage nationwide. HHS may contract for administrative functions akin to Medicare part D but without transferring insurance risk; states may form advisory councils to recommend on quality, cost control, and awareness; and HHS must collect data to set premiums, provider rates, and address disparities. Premiums must be geographically adjusted, fully finance benefits and administrative costs with a contingency margin, and vary only as permitted under ACA premium rules. Provider reimbursement rates are to be negotiated by HHS (with negotiations completed by January 1, 2026) or, if no agreement, set at original Medicare fee-for-service rates under parts A and B (with modifications for non-Medicare services such as well-child visits); prescription drug payments are negotiated separately. (Thus, the public option operates without federal subsidies or premium taxes applicable to private QHPs, potentially lowering costs through Medicare-like rates while competing directly with private plans on Exchanges.)