Sponsors (6)
Introduced June 11, 2025 by Jimmy Gomez · Last progress June 11, 2025
The bill expands and subsidizes more generous, federally backed health coverage (including reproductive care and a new public-plan option) to improve access and reduce patient costs, but does so at substantial federal expense and with risks of higher premiums, administrative complexity, and legal or market uncertainty.
Women and people seeking reproductive care (including federal employees) would gain broader, federally-modeled coverage for contraception, abortion, and related services, protecting access where State law restricts it.
Uninsured and individually insured people would be able to enroll in a new comprehensive federal public-plan option that matches Medicare-level benefits and gold actuarial value, lowering out-of-pocket costs and expanding provider participation through automatic Medicare-provider participation.
Middle‑income and lower‑income households would pay less for coverage because premium tax credits would become available above 400% FPL and the subsidy benchmark would shift to a gold plan while cost‑sharing protections would increase for 100–400% FPL enrollees, reducing net premiums and out‑of‑pocket costs.
Taxpayers would shoulder substantial new federal costs (start‑up funding for the public plan, expanded premium tax credits and cost‑sharing subsidies, and $30 billion for reinsurance), increasing federal spending and potential deficits unless offsets are found.
Insurers may raise premiums, narrow networks, tighten underwriting, or reduce benefits to offset higher required generosity and subsidy changes (gold benchmark, higher actuarial values), which could increase costs for unsubsidized consumers and reduce provider choice.
Federal preemption of state restrictions on reproductive services and expanded federal oversight (including federal corrective actions) could provoke legal challenges and state pushback, creating regulatory uncertainty and potential implementation delays.
Based on analysis of 10 sections of legislative text.
Creates federal Medicare part E plans in individual and group markets, shifts Marketplace subsidies to a gold benchmark, caps Medicare FFS out‑of‑pocket costs, funds a $30B reinsurance program, and strengthens rate review.
Creates a new federal “Medicare part E” set of public health plans that can be sold in the individual, small‑group, and large‑group markets and requires those plans to cover all essential health benefits including abortions and other reproductive services. It also changes Marketplace subsidy rules (moving the premium credit benchmark to a gold plan and removing the 400% FPL cap), establishes a $30 billion reinsurance and affordability fund for 2026–2028, caps annual out‑of‑pocket cost‑sharing for Medicare fee‑for‑service beneficiaries beginning in 2027, strengthens federal rate‑review enforcement, and requires certain employers to refer employees to exchange navigators. The bill affects consumers, employers, insurers, state regulators, and the federal budget by expanding coverage options, increasing federal subsidies and oversight, creating a federal plan option that preempts some state restrictions, and providing a multi‑year appropriation for reinsurance and affordability assistance. Many provisions take effect for plan or taxable years beginning after December 31, 2025, with the Medicare out‑of‑pocket cap starting in 2027 and the reinsurance program active for plan years beginning in 2026–2028.