I 

118TH CONGRESS 

2D SESSION H. R. 8207 

To provide for the establishment of Medicare part E public health plans, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 1, 2024 

Mr. GOMEZ (for himself, Mr. BEYER, Ms. NORTON, and Mr. HUFFMAN) introduced the following bill; which was referred to the Committee on Energy 

and Commerce, and in addition to the Committees on Education and the 

Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

A BILL 

To provide for the establishment of Medicare part E public 

health plans, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Choose Medicare Act’’. 

5 SEC. 2. PUBLIC HEALTH PLAN. 

6 (a) IN GENERAL.—The Social Security Act is amend7 ed by adding at the end the following: 


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1 ‘‘TITLE XXII—MEDICARE PART E PUBLIC HEALTH PLANS

2 ‘‘SEC. 2201. PUBLIC HEALTH PLANS.— 

3 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab4 lish public health plans (to be known as ‘Medicare part 

5 E plans’) that are available in the individual market, small 

6 group market, and large group market. 

7 ‘‘(b) BENEFITS.— 

8 ‘‘(1) IN GENERAL.—Each Medicare part E 

9 plan, regardless of whether the plan is offered in the 

10 individual market, small group market, or large 

11 group market, shall be a qualified health plan within 

12 the meaning of section 1301(a) of the Patient Pro13 tection and Affordable Care Act (42 U.S.C. 

14 18021(a)) that— 

15 ‘‘(A) meets all requirements applicable to 

16 qualified health plans under subtitle D of title 

17 I of the Patient Protection and Affordable Care 

18 Act (42 U.S.C. 18021 et seq.) (other than the 

19 requirement under section 1301(a)(1)(C)(ii) of 

20 such Act) and title XXVII of the Public Health 

21 Service Act (42 U.S.C. 300gg et seq.); 

22 ‘‘(B) provides coverage of— 

23 ‘‘(i) the essential health benefits de24 scribed in section 1302(b) of the Patient 


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1 Protection and Affordable Care Act (42 

2 U.S.C. 18022(b)); and 

3 ‘‘(ii) all items and services for which 

4 benefits are available under title XVIII; 

5 ‘‘(C) provides gold-level coverage described 

6 in section 1302(d)(1)(C) of the Patient Protec7 tion and Affordable Care Act (42 U.S.C. 

8 18022(d)(1)(C)); and 

9 ‘‘(D) provides coverage of abortions and all 

10 other reproductive services. 

11 ‘‘(2) PREEMPTION.—Notwithstanding section 

12 1303(a)(1) of the Patient Protection and Affordable 

13 Care Act (42 U.S.C. 18023(a)(1))— 

14 ‘‘(A) a State may not prohibit a Medicare 

15 part E plan from offering the coverage de16 scribed in paragraph (1)(D); and 

17 ‘‘(B) no provision of State law that would 

18 prohibit such a plan from offering such cov19 erage shall apply to such plan. 

20 ‘‘(c) ELIGIBILITY; ENROLLMENT.— 

21 ‘‘(1) AVAILABILITY ON THE EXCHANGES.—The 

22 Medicare part E plans offered in the individual and 

23 small group markets shall be offered through the 

24 Federal and State Exchanges, including the Small 


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1 Business Health Options Program Exchanges (com2 monly referred to as the ‘SHOP Exchanges’). 

3 ‘‘(2) ELIGIBILITY.— 

4 ‘‘(A) IN GENERAL.—Any individual who is 

5 a resident of the United States, as determined 

6 by the Secretary under subparagraph (C), and 

7 who is not an individual described in subpara8 graph (B), is eligible to enroll in a Medicare 

9 part E plan. 

10 ‘‘(B) EXCLUSIONS.—An individual de11 scribed in this subparagraph is any individual 

12 who is— 

13 ‘‘(i) entitled to, or enrolled for, bene14 fits under title XVIII; 

15 ‘‘(ii) eligible for medical assistance 

16 under a State plan under title XIX; or 

17 ‘‘(iii) enrolled for child health assist18 ance or pregnancy-related assistance under 

19 a State plan under title XXI. 

20 ‘‘(C) REGULATIONS.—The Secretary shall 

21 promulgate a rule for determining residency for 

22 purposes of subparagraph (A). 

23 ‘‘(3) EMPLOYER-SPONSORED PLANS.— 

24 ‘‘(A) EMPLOYER ENROLLMENT.—Effective 

25 with respect to the first plan year that begins 


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1 1 year after the date of enactment of the 

2 Choose Medicare Act and each plan year there3 after, the Secretary shall provide options for 

4 Medicare part E plans in the small group mar5 ket and large group market that are voluntary, 

6 and available to all employers. 

7 ‘‘(B) GROUP HEALTH PLANS.—The Sec8 retary, acting through the Administrator for the 

9 Centers for Medicare & Medicaid Services, at 

10 the request of a plan sponsor, shall serve as a 

11 third-party administrator of a group health 

12 plan that is a Medicare part E plan offered by 

13 such sponsor. 

14 ‘‘(C) PORTABILITY FOR EMPLOYER-SPON15 SORED PLANS.—The Secretary shall develop a 

16 process for allowing individuals enrolled in a 

17 Medicare part E plan offered in the small group 

18 market or large group market to maintain 

19 health insurance coverage through a Medicare 

20 part E plan if the individual subsequently loses 

21 eligibility for enrollment in such a plan based 

22 on termination of the employment relationship. 

23 The ability to maintain such coverage shall 

24 exist regardless of whether the individual has 

25 the option to enroll in other health insurance 


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1 coverage, including coverage offered in the indi2 vidual market or through a subsequent em3 ployer. 

4 ‘‘(d) PREMIUMS.—The Secretary shall establish pre5 mium rates for the Medicare part E plans that— 

6 ‘‘(1) are adjusted based on— 

7 ‘‘(A) whether the plan is offered in the in8 dividual market, small group market, or large 

9 group market; and 

10 ‘‘(B) the applicable rating area; 

11 ‘‘(2) are at a level sufficient to fully finance— 

12 ‘‘(A) the costs of health benefits provided 

13 by such plans; and 

14 ‘‘(B) administrative costs related to oper15 ating the plans; and 

16 ‘‘(3) comply with the requirements under sec17 tion 2701 of the Public Health Service Act (42 

18 U.S.C. 300gg), including for such plans that are of19 fered in the large group market. 

20 ‘‘(e) PROVIDERS AND REIMBURSEMENT RATES.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall estab22 lish a rate schedule for reimbursing types of health 

23 care providers furnishing items and services under 

24 the Medicare part E plans at rates that are conVerDate Sep 11 2014 23:42 May 30, 2024 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8207.IH H8207

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1 sistent with the negotiations described in paragraph 

2 (2) and are necessary to maintain network adequacy. 

3 ‘‘(2) MANNER OF NEGOTIATION.—The Sec4 retary shall negotiate the rates described in para5 graph (1) in a manner that results in payment rates 

6 that are not lower, in the aggregate, than rates 

7 under title XVIII, and not higher, in the aggregate, 

8 than the average rates paid by other health insur9 ance issuers offering health insurance coverage 

10 through an Exchange. 

11 ‘‘(3) PARTICIPATING PROVIDERS.— 

12 ‘‘(A) IN GENERAL.—A health care provider 

13 that is a participating provider of services or 

14 supplier under the Medicare program under 

15 title XVIII on the date of enactment of the 

16 Choose Medicare Act shall be a participating 

17 provider for Medicare part E plans. 

18 ‘‘(B) ADDITIONAL PROVIDERS.—The Sec19 retary shall establish a process to allow health 

20 care providers not described in subparagraph 

21 (A) to become participating providers for Medi22 care part E plans. 

23 ‘‘(4) LIMITATIONS ON BALANCE BILLING.—The 

24 limitations on balance billing pursuant to the provi25 sions of section 1866(a)(1)(A) shall apply to particiVerDate Sep 11 2014 23:42 May 30, 2024 Jkt 049200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8207.IH H8207

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1 pating providers for Medicare part E plans in the 

2 same manner as such provisions apply to partici3 pating providers under the Medicare program. 

4 ‘‘(f) ENCOURAGING USE OF ALTERNATIVE PAYMENT

5 MODELS.—The Secretary shall, as applicable, utilize alter6 native payment models, including those described in sec7 tion 1833(z)(3)(C), as added by section 101(e)(2) of the 

8 Medicare Access and CHIP Reauthorization Act of 2015 

9 (Public Law 114–10), in making payments for items and 

10 services (including prescription drugs) furnished under 

11 Medicare part E plans. The payment rates under such al12 ternative payment models shall comply with the require13 ment for negotiated rates under subsection (e)(2). 

14 ‘‘(g) PRESCRIPTION DRUGS.—The Secretary shall 

15 apply the provisions of part E of title XI to prescription 

16 drugs under Medicare part E plans in the same manner 

17 as such provisions apply with respect to selected drugs 

18 under part E of title XI. 

19 ‘‘(h) APPROPRIATIONS.— 

20 ‘‘(1) START UP FUNDING.—For purposes of es21 tablishing the Medicare part E plans, there is appro22 priated to the Secretary, out of any funds in the 

23 Treasury not otherwise obligated, $2,000,000,000, 

24 for fiscal year 2025. 


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1 ‘‘(2) INITIAL RESERVES.—There is appro2 priated to the Secretary, out of any funds in the 

3 Treasury not otherwise obligated, such sums as may 

4 be necessary, based on projected enrollment in the 

5 Medicare part E plans in the first plan year in 

6 which such plans are offered, to provide reserves for 

7 the purpose of paying claims filed during the initial 

8 90-day period of such plan year. 

9 ‘‘(3) CLARIFICATION.—Any provision of law re10 stricting the use of Federal funds with respect to 

11 any reproductive health service shall not apply to 

12 funds appropriated under paragraph (1) or (2). 

13 ‘‘(i) HEALTH INSURANCE ISSUER.—With respect to 

14 any Medicare part E plan, the Secretary shall be consid15 ered a health insurance issuer, within the meaning of sec16 tion 2791(b) of the Public Health Service Act (42 U.S.C. 

17 300gg–91(b)).’’. 

18 (b) APPLICATION OF EXCISE TAX FOR NONCOMPLI19 ANCE WITH NEGOTIATION REQUIREMENTS.—Section 

20 5000D(e)(1) of the Internal Revenue Code of 1986 is 

21 amended by adding at the end the following new sentence: 

22 ‘‘Such term shall apply to any drug treated in the same 

23 manner as a drug described in the preceding sentence by 

24 reason of section 2201(g) of the Social Security Act.’’. 


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1 SEC. 3. NOTICE AND NAVIGATOR REFERRAL FOR EMPLOY2 EES UNDER THE FAIR LABOR STANDARDS 

3 ACT OF 1938. 

4 (a) IN GENERAL.—Section 18B of the Fair Labor 

5 Standards Act of 1938 (29 U.S.C. 218b) is amended— 

6 (1) in the heading, by striking ‘‘TO’’ and insert7 ing ‘‘AND NAVIGATOR REFERRAL FOR’’; 

8 (2) by redesignating subsection (b) as sub9 section (c); and 

10 (3) by inserting after subsection (a) the fol11 lowing: 

12 ‘‘(b) NAVIGATOR REFERRAL.— 

13 ‘‘(1) IN GENERAL.—An employer described in 

14 paragraph (3) shall refer each full-time employee (as 

15 defined in section 4980H(c) of the Internal Revenue 

16 Code of 1986) to— 

17 ‘‘(A) an entity that serves as a navigator 

18 under section 1311(i) of the Patient Protection 

19 and Affordable Care Act (42 U.S.C. 18031(i)) 

20 for the Exchange operating in the State of the 

21 employer; or 

22 ‘‘(B) if the Exchange operating in the 

23 State of the employer does not have an entity 

24 serving as such a navigator, another entity that 

25 shall carry out equivalent activities as such a 

26 navigator. 


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1 ‘‘(2) REFERRAL.—The referral described in 

2 paragraph (1) shall occur— 

3 ‘‘(A) at the time the employer hires the 

4 employee; or 

5 ‘‘(B) on the effective date described in sub6 section (c)(2) with respect to an employee who 

7 is currently employed by the employer on such 

8 date. 

9 ‘‘(3) EMPLOYER.—An employer described in 

10 this paragraph is any employer that— 

11 ‘‘(A) does not provide an eligible employer12 sponsored plan as defined in section 

13 5000A(f)(2) of the Internal Revenue Code of 

14 1986; or 

15 ‘‘(B) provides such an eligible employer16 sponsored plan, but the plan is determined— 

17 ‘‘(i) to be unaffordable to the em18 ployee under clause (i) of section 

19 36B(c)(2)(C) of such Code; or 

20 ‘‘(ii) to not provide the required min21 imum value under clause (ii) of such sec22 tion.’’; and 

23 (4) in subsection (c), as so redesignated— 


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1 (A) in the heading, by striking ‘‘EFFEC2 TIVE DATE’’ and inserting ‘‘EFFECTIVE

3 DATES’’; 

4 (B) by striking ‘‘Subsection (a)’’ and in5 serting the following: 

6 ‘‘(1) NOTICE.—Subsection (a);’’; and 

7 (C) by adding at the end the following: 

8 ‘‘(2) NAVIGATOR REFERRAL.—Subsection (b) 

9 shall take effect with respect to employers in a State 

10 beginning on the date that is 2 years after the date 

11 of enactment of the Choose Medicare Act.’’. 

12 (b) STUDY.—Not later than January 1, 2029, the 

13 Comptroller General of the United States shall conduct 

14 a study on the impact of the requirements under section 

15 18B of the Fair Labor Standards Act of 1938 (29 U.S.C. 

16 218b), including the amendments made by subsection (a), 

17 on the rate of individuals without minimum essential cov18 erage as defined in section 5000A(f) of the Internal Rev19 enue Code of 1986 in the United States and in each State. 

20 (c) FUNDING FOR NAVIGATOR PROGRAM.—Section 

21 1311(i)(6) of the Patient Protection and Affordable Care 

22 Act (42 U.S.C. 18031(i)(6)) is amended— 

23 (1) by striking ‘‘Grants’’ and inserting the fol24 lowing: 

25 ‘‘(A) IN GENERAL.—Grants’’; and 


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1 (2) by adding at the end the following: 

2 ‘‘(B) AUTHORIZATION OF APPROPRIA3 TIONS.—There is authorized to be appropriated 

4 such sums as may be necessary to address ca5 pacity limitations of entities serving as naviga6 tors through a grant under this subsection.’’. 

7 SEC. 4. PROTECTING AGAINST HIGH OUT-OF-POCKET EX8 PENDITURES FOR MEDICARE FEE-FOR-SERV9 ICE BENEFITS. 

10 Title XVIII of the Social Security Act (42 U.S.C. 

11 1395 et seq.) is amended by adding at the end the fol12 lowing new section: 

13 ‘‘PROTECTION AGAINST HIGH OUT-OF-POCKET

14 EXPENDITURES

15 ‘‘SEC. 1899C. (a) IN GENERAL.—Notwithstanding 

16 any other provision of this title, in the case of an indi17 vidual entitled to, or enrolled for, benefits under part A 

18 or enrolled in part B, if the amount of the out-of-pocket 

19 cost-sharing of such individual for a year (beginning with 

20 2026) equals or exceeds the annual out-of-pocket limit 

21 under subsection (b) for that year, the individual shall not 

22 be responsible for additional out-of-pocket cost-sharing in23 curred during that year. 

24 ‘‘(b) ANNUAL OUT-OF-POCKET LIMIT.— 

25 ‘‘(1) IN GENERAL.—The amount of the annual 

26 out-of-pocket limit under this subsection shall be— 


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1 ‘‘(A) for 2026, $6,700; or 

2 ‘‘(B) for a subsequent year, the amount 

3 specified in this subsection for the preceding 

4 year increased or decreased by the percentage 

5 change in the medical care component of the 

6 Consumer Price Index for All Urban Con7 sumers for the 12-month period ending with 

8 June of such preceding year. 

9 ‘‘(2) ROUNDING.—If any amount determined 

10 under paragraph (1)(B) is not a multiple of $5, such 

11 amount shall be rounded to the nearest multiple of 

12 $5. 

13 ‘‘(c) OUT-OF-POCKET COST-SHARING DEFINED.— 

14 ‘‘(1) IN GENERAL.—Subject to paragraphs (2) 

15 and (3), in this section, the term ‘out-of-pocket cost16 sharing’ means, with respect to an individual, the 

17 amount of the expenses incurred by the individual 

18 that are attributable to— 

19 ‘‘(A) deductibles, coinsurance, and copay20 ments applicable under part A or B; or 

21 ‘‘(B) for items and services that would 

22 have otherwise been covered under part A or B 

23 but for the exhaustion of those benefits. 

24 ‘‘(2) CERTAIN COSTS NOT INCLUDED.— 


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1 ‘‘(A) NON-COVERED ITEMS AND SERV2 ICES.—Expenses incurred for items and serv3 ices which are not covered under part A or B 

4 shall not be considered incurred expenses for 

5 purposes of determining out-of-pocket cost6 sharing under paragraph (1). 

7 ‘‘(B) ITEMS AND SERVICES NOT FUR8 NISHED ON AN ASSIGNMENT-RELATED BASIS.— 

9 If an item or service is furnished to an indi10 vidual under this title and is not furnished on 

11 an assignment-related basis, any additional ex12 penses the individual incurs above the amount 

13 the individual would have incurred if the item 

14 or service was furnished on an assignment-re15 lated basis shall not be considered incurred ex16 penses for purposes of determining out-of-pock17 et cost-sharing under paragraph (1). 

18 ‘‘(3) SOURCE OF PAYMENT.—For purposes of 

19 paragraph (1), the Secretary shall consider expenses 

20 to be incurred by the individual without regard to 

21 whether the individual or another person, including 

22 a State program, an employer, a medicare supple23 mental policy, or other third-party coverage, has 

24 paid for such expenses. 


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1 ‘‘(d) ANNOUNCEMENT OF THE ANNUAL OUT-OF2 POCKET LIMIT.—The Secretary shall (beginning in 2025) 

3 announce (in a manner intended to provide notice to all 

4 interested parties) the annual out-of-pocket limit under 

5 this section that will be applicable for the succeeding 

6 year.’’. 

7 SEC. 5. ENHANCEMENT OF PREMIUM ASSISTANCE CREDIT. 

8 (a) USE OF GOLD LEVEL PLAN FOR BENCHMARK.— 

9 (1) IN GENERAL.—Clause (i) of section 

10 36B(b)(2)(B) of the Internal Revenue Code of 1986 

11 is amended by striking ‘‘applicable second lowest 

12 cost silver plan’’ and inserting ‘‘applicable second 

13 lowest cost gold plan’’. 

14 (2) CONFORMING AMENDMENT RELATED TO

15 AFFORDABILITY.—Section 36B(c)(4)(C)(i)(I) of 

16 such Code is amended by striking ‘‘second lowest 

17 cost silver plan’’ and inserting ‘‘second lowest cost 

18 gold plan’’. 

19 (3) OTHER CONFORMING AMENDMENTS.—Sub20 paragraphs (B) and (C) of section 36B(b)(3) of such 

21 Code are each amended by striking ‘‘silver plan’’ 

22 each place it appears in the text and the heading 

23 and inserting ‘‘gold plan’’. 

24 (b) PERMANENT EXTENSION OF ELIGIBILITY

25 RULES.— 


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1 (1) IN GENERAL.—Section 36B(c)(1) of the In2 ternal Revenue Code of 1986 is amended— 

3 (A) in subparagraph (A), by striking ‘‘but 

4 does not exceed 400 percent’’, and 

5 (B) by striking subparagraph (E). 

6 (2) DETERMINATION OF APPLICABLE PERCENT7 AGE.—Subparagraph (A) of section 36B(b)(3) of 

8 such Code is amended by striking all that precedes 

9 the table in clause (iii)(II) and inserting the fol10 lowing: 

11 ‘‘(A) APPLICABLE PERCENTAGE.—For 

12 purposes of paragraph (2), except as provided 

13 in clause (ii), the applicable percentage for any 

14 taxable year shall be the percentage such that 

15 the applicable percentage for any taxpayer 

16 whose household income is within an income 

17 tier specified in the following table shall in18 crease, on a sliding scale in a linear manner, 

19 from the initial premium percentage to the final 

20 premium percentage specified in such table for 

21 such income tier:’’. 

22 (c) EFFECTIVE DATE.—The amendments made by 

23 this section shall apply to taxable years beginning after 

24 December 31, 2023. 


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1 SEC. 6. ENHANCEMENTS FOR REDUCED COST SHARING. 

2 (a) DEFINITION OF ELIGIBLE INDIVIDUAL.—Section 

3 1402(b)(1) of the Patient Protection and Affordable Care 

4 Act (42 U.S.C. 18071(b)(1)) is amended by striking ‘‘sil5 ver level’’ and inserting ‘‘gold level’’. 

6 (b) MODIFICATION OF AMOUNT.— 

7 (1) IN GENERAL.—Section 1402(c)(2) of the 

8 Patient Protection and Affordable Care Act is 

9 amended to read as follows: 

10 ‘‘(2) ADDITIONAL REDUCTION.—The Secretary 

11 shall establish procedures under which the issuer of 

12 a qualified health plan to which this section applies 

13 shall further reduce cost-sharing under the plan in 

14 a manner sufficient to— 

15 ‘‘(A) in the case of an eligible insured 

16 whose household income is not less than 100 

17 percent but not more than 133 percent of the 

18 poverty line for a family of the size involved, in19 crease the plan’s share of the total allowed 

20 costs of benefits provided under the plan to 94 

21 percent of such costs; 

22 ‘‘(B) in the case of an eligible insured 

23 whose household income is more than 133 per24 cent but not more than 150 percent of the pov25 erty line for a family of the size involved, in26 crease the plan’s share of the total allowed 


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1 costs of benefits provided under the plan to 92 

2 percent of such costs; 

3 ‘‘(C) in the case of an eligible insured 

4 whose household income is more than 150 per5 cent but not more than 200 percent of the pov6 erty line for a family of the size involved, in7 crease the plan’s share of the total allowed 

8 costs of benefits provided under the plan to 90 

9 percent of such costs; 

10 ‘‘(D) in the case of an eligible insured 

11 whose household income is more than 200 per12 cent but not more than 300 percent of the pov13 erty line for a family of the size involved, in14 crease the plan’s share of the total allowed 

15 costs of benefits provided under the plan to 85 

16 percent of such costs; and 

17 ‘‘(E) in the case of an eligible insured 

18 whose household income is more than 300 per19 cent but not more than 400 percent of the pov20 erty line for a family of the size involved, in21 crease the plan’s share of the total allowed 

22 costs of benefits provided under the plan to 80 

23 percent of such costs.’’. 


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1 (2) CONFORMING AMENDMENT.—Clause (i) of 

2 section 1402(c)(1)(B) of such Act is amended to 

3 read as follows: 

4 ‘‘(i) IN GENERAL.—The Secretary 

5 shall ensure the reduction under this para6 graph shall not result in an increase in the 

7 plan’s share of the total allowed costs of 

8 benefits provided under the plan above— 

9 ‘‘(I) 94 percent in the case of an 

10 eligible insured described in para11 graph (2)(A); 

12 ‘‘(II) 92 percent in the case of an 

13 eligible insured described in para14 graph (2)(B); 

15 ‘‘(III) 90 percent in the case of 

16 an eligible insured described in para17 graph (2)(C); 

18 ‘‘(IV) 85 percent in the case of 

19 an eligible insured described in para20 graph (2)(D); and 

21 ‘‘(V) 80 percent in the case of an 

22 eligible insured described in para23 graph (2)(E).’’. 


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1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to plan years beginning after De3 cember 31, 2024. 

4 SEC. 7. REINSURANCE AND AFFORDABILITY FUND. 

5 Part 5 of subtitle D of title I of the Patient Protec6 tion and Affordable Care Act is amended by inserting 

7 after section 1341 (42 U.S.C. 18061) the following: 

8 ‘‘SEC. 1341A. REINSURANCE AND AFFORDABILITY FUND 

9 FOR THE INDIVIDUAL MARKET IN EACH 

10 STATE. 

11 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

12 with the National Association of Insurance Commis13 sioners, shall establish a program to enable each State, 

14 for any plan year beginning in the 3-year period beginning 

15 January 1, 2025, to— 

16 ‘‘(1) provide reinsurance payments to health in17 surance issuers with respect to individuals enrolled 

18 under individual health insurance coverage offered 

19 by such issuers; or 

20 ‘‘(2) provide assistance (other than through 

21 payments described in paragraph (1)) to reduce out22 of-pocket costs, such as copayments, coinsurance, 

23 premiums, and deductibles, of individuals enrolled 

24 under qualified health plans offered in the individual 

25 market through an Exchange. 


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1 ‘‘(b) APPROPRIATIONS.—There is appropriated, out 

2 of any money in the Treasury not otherwise appropriated, 

3 $30,000,000,000 for the period of fiscal years 2025 to 

4 2027 for purposes of establishing and administering the 

5 program established under this section. Such amount shall 

6 remain available until expended.’’. 

7 SEC. 8. EXPANDING RATING RULES TO LARGE GROUP MAR8 KET. 

9 (a) IN GENERAL.—Section 2701(a) of the Public 

10 Health Service Act (42 U.S.C. 300gg(a)) is amended— 

11 (1) in paragraph (1), by striking ‘‘small’’; and 

12 (2) by striking paragraph (5). 

13 (b) EFFECTIVE DATE.—The amendments made by 

14 subsection (a) shall apply to plans offered in the first plan 

15 year beginning after the date of enactment of this Act and 

16 any plan year thereafter. 

17 SEC. 9. PROTECTION OF CONSUMERS FROM EXCESSIVE, 

18 UNJUSTIFIED, OR UNFAIRLY DISCRIMINA19 TORY RATES. 

20 (a) PROTECTION FROM EXCESSIVE, UNJUSTIFIED, 

21 OR UNFAIRLY DISCRIMINATORY RATES.—Section 2794 of 

22 the Public Health Service Act (42 U.S.C. 300gg–94) is 

23 amended by adding at the end the following new sub24 section: 


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1 ‘‘(e) PROTECTION FROM EXCESSIVE, UNJUSTIFIED, 

2 OR UNFAIRLY DISCRIMINATORY RATES.— 

3 ‘‘(1) AUTHORITY OF STATES.—Nothing in this 

4 section shall be construed to prohibit a State from 

5 imposing requirements (including requirements re6 lating to rate review standards and procedures and 

7 information reporting) on health insurance issuers 

8 with respect to rates that are in addition to the re9 quirements of this section and are more protective of 

10 consumers than such requirements. 

11 ‘‘(2) CONSULTATION IN RATE REVIEW PROC12 ESS.—In carrying out this section, the Secretary 

13 shall consult with the National Association of Insur14 ance Commissioners and consumer groups. 

15 ‘‘(3) DETERMINATION OF WHO CONDUCTS RE16 VIEWS FOR EACH STATE.—The Secretary shall de17 termine, after the date of enactment of this sub18 section and periodically thereafter, the following: 

19 ‘‘(A) In which markets in each State the 

20 State insurance commissioner or relevant State 

21 regulator shall undertake the corrective actions 

22 under paragraph (4), based on the Secretary’s 

23 determination that the State insurance commis24 sioner or relevant State regulator is adequately 


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1 undertaking and utilizing such actions in that 

2 market. 

3 ‘‘(B) In which markets in each State the 

4 Secretary shall undertake the corrective actions 

5 under paragraph (4), in cooperation with the 

6 relevant State insurance commissioner or State 

7 regulator, based on the Secretary’s determina8 tion that the State is not adequately under9 taking and utilizing such actions in that mar10 ket. 

11 ‘‘(4) CORRECTIVE ACTION FOR EXCESSIVE, UN12 JUSTIFIED, OR UNFAIRLY DISCRIMINATORY

13 RATES.—In accordance with the process established 

14 under this section, the Secretary or the relevant 

15 State insurance commissioner or State regulator 

16 shall take corrective actions to ensure that any ex17 cessive, unjustified, or unfairly discriminatory rates 

18 are corrected prior to implementation, or as soon as 

19 possible thereafter, through mechanisms such as— 

20 ‘‘(A) denying rates; 

21 ‘‘(B) modifying rates; or 

22 ‘‘(C) requiring rebates to consumers. 

23 ‘‘(5) NONCOMPLIANCE.— 

24 ‘‘(A) IN GENERAL.—Failure to comply 

25 with any corrective action taken by the SecVerDate Sep 11 2014 23:42 May 30, 2024 Jkt 049200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H8207.IH H8207

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1 retary under this subsection may result in the 

2 application of civil monetary penalties described 

3 in subparagraph (B) and, if the Secretary de4 termines appropriate, make the plan involved 

5 ineligible for classification as a qualified health 

6 plan. 

7 ‘‘(B) CIVIL MONETARY PENALTIES.— 

8 ‘‘(i) IN GENERAL.—The provisions of 

9 section 1128A of the Social Security Act, 

10 other than subsection (a) and (b) and the 

11 first sentence of subsection (c)(1) of such 

12 section, shall apply to civil monetary pen13 alties under this paragraph in the same 

14 manner as such provisions apply to a pen15 alty or proceeding under section 1128A of 

16 the Social Security Act. 

17 ‘‘(ii) AMOUNT.—The provisions of 

18 subparagraph (C) of section 2723(b)(2) 

19 shall apply to civil monetary penalties 

20 under this paragraph in the same manner 

21 as such provisions apply to a penalty under 

22 such section.’’. 

23 (b) CLARIFICATION OF REGULATORY AUTHORITY.— 

24 Section 2794 of the Public Health Service Act (42 U.S.C. 

25 300gg–94) is further amended— 


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1 (1) in subsection (a)— 

2 (A) in the subsection heading, by striking 

3 ‘‘PREMIUM’’ and inserting ‘‘RATE’’; 

4 (B) in paragraph (1), by striking ‘‘unrea5 sonable increases in premiums’’ and inserting 

6 ‘‘potentially excessive, unjustified, or unfairly 

7 discriminatory rates, including premiums,’’; and 

8 (C) in paragraph (2)— 

9 (i) by striking ‘‘an unreasonable pre10 mium increase’’ and inserting ‘‘a poten11 tially excessive, unjustified, or unfairly dis12 criminatory rate’’; 

13 (ii) by striking ‘‘the increase’’ and in14 serting ‘‘the rate’’; and 

15 (iii) by striking ‘‘such increases’’ and 

16 inserting ‘‘such rates’’; and 

17 (2) in subsection (b)— 

18 (A) in the subsection heading, by striking 

19 ‘‘PREMIUM’’ and inserting ‘‘RATE’’; 

20 (B) by striking ‘‘premium increases’’ each 

21 place it appears and inserting ‘‘rates’’; 

22 (C) in paragraph (1)— 

23 (i) in the paragraph heading, by strik24 ing ‘‘PREMIUM INCREASE’’ and inserting 

25 ‘‘RATE’’; and 


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1 (ii) in subparagraph (B), by striking 

2 ‘‘excessive or unjustified’’ and inserting 

3 ‘‘excessive, unjustified, or unfairly discrimi4 natory’’; and 

5 (D) in paragraph (2)— 

6 (i) in the paragraph heading, by strik7 ing ‘‘PREMIUM INCREASES’’ and inserting 

8 ‘‘RATES’’; and 

9 (ii) in subparagraph (B), by striking 

10 ‘‘premium’’ and inserting ‘‘rate’’. 

11 (c) CONFORMING AMENDMENT.—Section 1311(e)(2) 

12 of the Patient Protection and Affordable Care Act (42 

13 U.S.C. 18031(e)(2)) is amended by striking ‘‘excessive or 

14 unjustified premium increases’’ and inserting ‘‘excessive, 

15 unjustified, or unfairly discriminatory rates’’. 

16 (d) APPLICABILITY TO GRANDFATHERED HEALTH

17 PLANS.—Section 1251(a)(5) of the Patient Protection 

18 and Affordable Care Act (42 U.S.C. 18011(a)(5)) is 

19 amended— 

20 (1) by striking ‘‘Sections 2799A–1’’ and insert21 ing the following: 

22 ‘‘(A) IN GENERAL.—Sections 2799A–1’’; 

23 and 

24 (2) by adding at the end the following: 


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1 ‘‘(B) ENSURING THAT CONSUMERS GET

2 VALUE FOR THEIR DOLLARS.—Section 2794 of 

3 the Public Health Service Act shall apply to 

4 grandfathered health plans for plan years be5 ginning on or after January 1, 2025.’’. 

6 (e) EFFECTIVE DATE.—The amendments made by 

7 this section shall take effect on the date of enactment of 

8 this Act and shall be implemented with respect to health 

9 plans beginning not later than January 1, 2025. 

10 SEC. 10. SENSE OF CONGRESS. 

11 It is the sense of the Congress that— 

12 (1) the Federal Government, acting in its ca13 pacity as an insurer, employer, or health care pro14 vider, should serve as a model for the Nation to en15 sure coverage of all reproductive services; and 

16 (2) all restrictions on coverage of reproductive 

17 services in the private insurance market should end. 

Æ 


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