H.R. 7023

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7023 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 7023

To amend the Patient Protection and Affordable Care Act to establish a 
public health insurance option, and for other purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

January 12, 2026

Ms. Schakowsky (for herself, Mr. Cohen, Ms. Norton, Ms. Johnson of 
Texas, and Ms. Moore of Wisconsin) introduced the following bill; which 
was referred to the Committee on Energy and Commerce

_______________________________________________________________________

A BILL

To amend the Patient Protection and Affordable Care Act to establish a 
public health insurance option, and for other purposes.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Affordable Consumer Health Options 
and Insurance Competition Enhancement Act'' or the ``Affordable CHOICE 
Act''.

SEC. 2. PUBLIC HEALTH INSURANCE OPTION.

(a) In General.--Part 2 of subtitle D of title I of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18031 et seq.) is amended 
by adding at the end the following:

``SEC. 1314. PUBLIC HEALTH INSURANCE OPTION.

``(a) Establishment.--
``(1) In general.--For plan years beginning on or after 
January 1, 2027, the Secretary shall establish, and provide for 
the offering through the Exchanges of, a qualified health plan 
(in this section referred to as the `public health insurance 
option') that provides value, choice, competition, and 
stability of affordable, high-quality coverage throughout the 
United States in accordance with this section.
``(2) Primary responsibility.--In designing the public 
health insurance option, the primary responsibility of the 
Secretary shall be to create an affordable health plan without 
compromising quality or access to care.
``(b) Administrating the Public Health Insurance Option.--
``(1) Offered through exchanges.--
``(A) Exclusive to exchanges.--The public health 
insurance option shall be offered exclusively by the 
Secretary through the Exchanges and not by a health 
insurance issuer.
``(B) Ensuring a level playing field.--Except as 
otherwise provided under this section, the public 
health insurance option shall comply with requirements 
under this title, and title XXVII of the Public Health 
Service Act, that are applicable to health plans 
offered through the Exchanges, including requirements 
related to benefits, benefit levels, provider networks, 
notices, consumer protections, and cost-sharing.
``(C) Provision of benefit levels.--The public 
health insurance option shall offer bronze, silver, and 
gold plans.
``(2) Administrative contracting.--
``(A) Authorities.--The Secretary may enter into 
contracts for the purpose of performing administrative 
functions (including functions described in subsection 
(a)(4) of section 1874A of the Social Security Act) 
with respect to the public health insurance option in 
the same manner as the Secretary may enter into 
contracts under subsection (a)(1) of such section. The 
Secretary shall have the same authority with respect to 
the public health insurance option as the Secretary has 
under such subsection (a)(1) and subsection (b) of 
section 1874A of the Social Security Act with respect 
to title XVIII of such Act.
``(B) Transfer of insurance risk.--Any contract 
under this paragraph shall not involve the transfer of 
insurance risk from the Secretary to the entity 
entering into such contract with the Secretary.
``(3) State advisory council.--
``(A) Establishment.--A State may establish a 
public or nonprofit entity to serve as the State 
Advisory Council to provide recommendations to the 
Secretary on the operations and policies of the public 
health insurance option offered through the Exchange 
operating in the State.
``(B) Recommendations.--A State Advisory Council 
established under subparagraph (A) shall provide 
recommendations on at least the following:
``(i) Policies and procedures to integrate 
quality improvement and cost containment 
mechanisms into the health care delivery 
system.
``(ii) Mechanisms to facilitate public 
awareness of the availability of the public 
health insurance option.
``(iii) Alternative payment models and 
value-based insurance design under the public 
health insurance option that encourage quality 
improvement and cost control.
``(C) Members.--The members of any State Advisory 
Council shall be representatives of the public and 
include health care consumers and health care 
providers.
``(D) Applicability of recommendations.--The 
Secretary may apply the recommendations of a State 
Advisory Council to the public health insurance option 
in that State, in any other State, or in all States.
``(4) Data collection.--The Secretary shall collect such 
data as may be required--
``(A) to establish rates for premiums and health 
care provider reimbursement under subsection (c); and
``(B) for other purposes under this section, 
including to improve quality, and reduce racial, 
ethnic, and other disparities, in health and health 
care.
``(c) Financing the Public Health Insurance Option.--
``(1) Premiums.--
``(A) Establishment.--The Secretary shall establish 
geographically adjusted premium rates for the public 
health insurance option--
``(i) in a manner that complies with the 
requirement for premium rates under 
subparagraph (C) and considers the data 
collected under subsection (b)(4); and
``(ii) at a level sufficient to fully 
finance--
``(I) the costs of health benefits 
provided by the public health insurance 
option; and
``(II) administrative costs related 
to operating the public health 
insurance option.
``(B) Contingency margin.--In establishing premium 
rates under subparagraph (A), the Secretary shall 
include an appropriate amount for a contingency margin.
``(C) Variations in premium rates.--The premium 
rate charged for the public health insurance option may 
not vary except as provided under section 2701 of the 
Public Health Service Act.
``(2) Health care provider payment rates for items and 
services.--
``(A) In general.--
``(i) Rates negotiated by the secretary.--
Not later than January 1, 2026, and except as 
provided in clause (ii), the Secretary shall, 
through a negotiated agreement with health care 
providers, establish rates for reimbursing 
health care providers for providing the 
benefits covered by the public health insurance 
option.
``(ii) Medicare reimbursement rates.--If 
the Secretary and health care providers are 
unable to reach a negotiated agreement on a 
reimbursement rate, the Secretary shall 
reimburse providers at rates determined for 
equivalent items and services under the 
original Medicare fee-for-service program under 
parts A and B of title XVIII of the Social 
Security Act.
``(iii) For new services.--The Secretary 
shall modify reimbursement rates described in 
clause (ii) in order to accommodate payments 
for services, such as well-child visits, that 
are not otherwise covered under the original 
Medicare fee-for-service program.
``(B) Prescription drugs.--Any payment rate under 
this subsection for a prescription drug shall be at a 
rate negotiated by the Secretary. If the Secretary is 
unable to reach a negotiated agreement on such a 
reimbursement rate, the Secretary shall use rates 
determined for equivalent drugs paid for under the 
original Medicare fee-for-service program. The 
Secretary shall modify such rates in order to 
accommodate payments for drugs that are not otherwise 
covered under the original Medicare fee-for-service 
program.
``(3) Account.--
``(A) Establishment.--There is established in the 
Treasury of the United States an account for the 
receipts and disbursements attributable to the 
operation of the public health insurance option, 
including the start-up funding under subparagraph (C) 
and appropriations authorized under subparagraph (D).
``(B) Prohibition of state imposition of taxes.--
Section 1854(g) of the Social Security Act shall apply 
to receipts and disbursements described in subparagraph 
(A) in the same manner as such section applies to 
payments or premiums described in such section.
``(C) Start-up funding.--
``(i) Authorization of funding.--There are 
authorized to be appropriated such sums as may 
be necessary to establish the public health 
insurance option and cover 90 days of claims 
reserves based on projected enrollment.
``(ii) Amortization of start-up funding.--
The Secretary shall provide for the repayment 
of the start-up funding provided under clause 
(i) to the Treasury in an amortized manner over 
the 10-year period beginning on January 1, 
2027.
``(D) Additional authorization of appropriations.--
To carry out paragraph (2) of subsection (b), there are 
authorized to be appropriated such sums as may be 
necessary.
``(d) Health Care Provider Participation.--
``(1) Provider participation.--
``(A) In general.--The Secretary shall establish 
conditions of participation for health care providers 
under the public health insurance option.
``(B) Licensure or certification.--The Secretary 
shall not allow a health care provider to participate 
in the public health insurance option unless such 
provider is appropriately licensed or certified under 
State law.
``(2) Establishment of a provider network.--
``(A) Medicare and medicaid participating 
providers.--A health care provider that is a 
participating provider of services or supplier under 
the Medicare program under title XVIII of the Social 
Security Act or under a State Medicaid plan under title 
XIX of such Act is a participating provider in the 
public health insurance option unless the health care 
provider opts out of participating in the public health 
insurance option through a process established by the 
Secretary.
``(B) Additional providers.--The Secretary shall 
establish a process to allow health care providers not 
described in subparagraph (A) to become participating 
providers in the public health insurance option.''.
(b) Conforming Amendments.--
(1) Treatment as a qualified health plan.--Section 1301(a) 
of the Patient Protection and Affordable Care Act (42 U.S.C. 
18021(a)) is amended--
(A) in paragraph (1)(C), by inserting ``except in 
the case of the public health insurance option 
established under section 1314,'' before ``is offered 
by'';
(B) in paragraph (2)--
(i) in the paragraph heading, by inserting 
``, the public health insurance option,'' 
before ``and''; and
(ii) by inserting ``the public health 
insurance option under section 1314,'' before 
``and a multi-State plan''; and
(C) by adding at the end the following:
``(5) Public health insurance option.--The term `qualified 
health plan' shall include the public health insurance option 
established under section 1314.''.
(2) Level playing field.--Section 1324(a) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18044(a)) is 
amended by inserting ``the public health insurance option under 
section 1314,'' before ``or a multi-State qualified health 
plan''.
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