Sponsors (12)
This is not an official government website.
Copyright © 2026 PLEJ LC. All rights reserved.
Creates a new federal public-plan option called Medicare Part E that private individuals and employers can buy through Exchanges and employer plans, requires that these plans cover Medicare benefits plus all essential health and reproductive services (including abortion), and preempts state bans on such coverage. It also sets provider payment rules, authorizes initial federal funding, and makes the federal government the plan issuer. Moves the ACA subsidy and cost-sharing rules to the gold plan standard (raising subsidies and cost-sharing protections), removes the 400% FPL subsidy cap, creates a $30 billion reinsurance and affordability fund for 2026–2028, adds an annual out-of-pocket limit for traditional Medicare starting 2027, requires employer referrals to Exchange navigators for uninsured or unaffordable plans, expands federal rate-setting and review authority, and changes market rating rules to apply beyond the small-group market.
The bill expands coverage, affordability, and consumer protections—especially for low‑ and moderate‑income people and Medicare beneficiaries—while substantially increasing federal costs and creating risks of higher premiums for some, market disruption, administrative burdens, and uneven state‑level outcomes.
Millions of low- and moderate-income consumers (including many middle-class families) will pay substantially less in premiums because premium tax credits expand (removing the 400% FPL cap) and the benchmark for credits shifts to a higher-value plan.
Low-income enrollees (roughly 100%–400% FPL) will face much lower out-of-pocket costs because plans must have higher actuarial values and enhanced cost‑sharing reductions, improving access to care.
A new public Medicare Part E option will expand coverage choices (including guaranteed coverage for abortion and other reproductive services where applicable), import participating Medicare providers into networks, and apply drug negotiation/price mechanisms that may lower prescription costs.
Federal spending and budget pressure rise materially (start‑up costs for new Part E, expanded premium tax credits, and a $30 billion temporary fund), increasing costs to taxpayers and potentially the deficit unless offset.
Some consumers—particularly unsubsidized buyers and those currently on silver plans using CSR—could face higher premiums or higher out‑of‑pocket costs because the benchmark shifts to gold and mandated higher actuarial values may push up prices.
Insurers and providers may respond to mandate, payment, and generosity changes by narrowing networks, exiting markets, or raising prices, which could reduce plan choice and access in some areas.
Introduced June 11, 2025 by Jeff Merkley · Last progress June 11, 2025