“A bill 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 establishes a public health insurance option, to be offered exclusively by the Secretary of Health and Human Services (HHS) through the Exchanges as a qualified health plan (i.e., complying with applicable requirements for benefits, provider networks, consumer protections, and cost-sharing under the Patient Protection and Affordable Care Act [ACA]) for plan years beginning on or after January 1, 2027. The option must offer bronze, silver, and gold coverage levels; HHS may contract for administrative functions akin to those for Medicare parts A and B (without transferring insurance risk); states may create advisory councils to recommend on quality, cost controls, and awareness; and HHS must collect data to set premiums and payments while improving quality and reducing disparities. Premiums for the option must be geographically adjusted, fully fund benefits and administrative costs (including a contingency margin), and vary only as permitted under the Public Health Service Act. Provider reimbursement rates must be negotiated by HHS (by January 1, 2026), defaulting to original Medicare fee-for-service rates under parts A and B if no agreement is reached (with modifications for non-Medicare services such as well-child visits); prescription drug payments must be negotiated by HHS.