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Introduced June 11, 2025 by Jimmy Gomez · Last progress June 11, 2025
Creates a new public insurance option called “Medicare part E” available on individual, small-group, and large-group markets that must cover essential benefits, Medicare-covered services, and all reproductive services (including abortions), with federal preemption of state limits. Raises ACA standards: changes the subsidy benchmark to a gold plan, expands premium tax credit eligibility, increases cost‑sharing reductions, and funds a temporary federal reinsurance/affordability program. Establishes an annual out‑of‑pocket cap for traditional Medicare beneficiaries starting in 2027, requires certain employers to refer employees to marketplace navigators, strengthens federal review and remedies for excessive insurance rates, and provides upfront federal startup and reinsurance appropriations.
The bill expands and standardizes coverage and affordability (including reproductive services, larger subsidies, CSR reform, reinsurance, and a new federal plan) to lower costs and increase access for many Americans, but does so at substantial federal expense and with risks of market disruption, legal conflict, and implementation challenges.
Low- and moderate-income Americans (and many middle-class families) would pay lower net premiums and see smoother, more generous premium tax credits because the subsidy benchmark shifts to a gold plan, the 400% FPL cap is removed, and credit phases are graduated.
Uninsured people and others without Medicare/Medicaid/CHIP gain access to a new federally backed comprehensive plan that includes Medicare-level benefits and required coverage of abortion and reproductive services, with $2 billion in startup funding and automatic participation by current Medicare providers.
States and individual-market enrollees would receive short-term market stabilization through a three-year $30 billion federal reinsurance/cost-support program, which should lower premiums and out-of-pocket costs for people who buy individual plans.
Taxpayers and federal finances would face substantially larger costs—from $2 billion in startup funds to expanded subsidy formulas and a $30 billion reinsurance fund—raising the federal deficit risk or creating pressure for offsets or cuts elsewhere.
Price-setting, negotiated payment caps, stronger rate enforcement, and new penalty authorities could disrupt insurer and provider participation—leading to narrower networks, reduced competition, or fewer plan choices in some areas.
Federal preemption of state abortion restrictions and expansion of federally funded reproductive coverage invites legal and political conflict with states, risking litigation, implementation delays, and uneven access across jurisdictions.