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Affordable CHOICE Act
Introduced Jan 12, 2026 · Last action Jan 12, 2026 — Referred to the House Committee on Energy and Commerce.
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Summary
This legislation is called the Affordable CHOICE Act. Referred to the House Committee on Energy and Commerce.
Full bill text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7023 Introduced in House (IH)]
<DOC>
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''.
<all>Official legislative text sourced from the public record (cached on CivicsHQ).
Official source
View the original bill, actions, and full legislative record on Congress.gov.
Status
In Committee
- 1Introduced
- 2Committee
- 3Floor
- 4Passed
- 5Signed
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