I 
119TH CONGRESS 
1ST SESSION H. R. 3911 
To provide for the establishment of Medicare part E public health plans, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 11, 2025 
Mr. GOMEZ (for himself, Mr. BEYER, Mr. HUFFMAN, Mrs. MCIVER, and Ms. 
NORTON) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Ways and Means, and Education and Workforce, for a period to be sub-
sequently 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Choose Medicare Act’’. 
SEC. 2. PUBLIC HEALTH PLAN. 
(a) IN GENERAL.—The Social Security Act is amend-
ed by adding at the end the following: 
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‘‘TITLE XXII—MEDICARE PART E PUBLIC HEALTH PLANS 
‘‘SEC. 2201. PUBLIC HEALTH PLANS.— 
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish public health plans (to be known as ‘Medicare part 
E plans’) that are available in the individual market, small 
group market, and large group market. 
‘‘(b) BENEFITS.— 
‘‘(1) IN
GENERAL.—Each Medicare part E 
plan, regardless of whether the plan is offered in the 
individual market, small group market, or large 
group market, shall be a qualified health plan within 
the meaning of section 1301(a) of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 
18021(a)) that— 
‘‘(A) meets all requirements applicable to 
qualified health plans under subtitle D of title 
I of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18021 et seq.) (other than the 
requirement under section 1301(a)(1)(C)(ii) of 
such Act) and title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg et seq.); 
‘‘(B) provides coverage of— 
‘‘(i) the essential health benefits de-
scribed in section 1302(b) of the Patient 
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Protection and Affordable Care Act (42 
U.S.C. 18022(b)); and 
‘‘(ii) all items and services for which 
benefits are available under title XVIII; 
‘‘(C) provides gold-level coverage described 
in section 1302(d)(1)(C) of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 
18022(d)(1)(C)); and 
‘‘(D) provides coverage of abortions and all 
other reproductive services. 
‘‘(2) PREEMPTION.—Notwithstanding section 
1303(a)(1) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18023(a)(1))— 
‘‘(A) a State may not prohibit a Medicare 
part E plan from offering the coverage de-
scribed in paragraph (1)(D); and 
‘‘(B) no provision of State law that would 
prohibit such a plan from offering such cov-
erage shall apply to such plan. 
‘‘(c) ELIGIBILITY; ENROLLMENT.— 
‘‘(1) AVAILABILITY ON THE EXCHANGES.—The 
Medicare part E plans offered in the individual and 
small group markets shall be offered through the 
Federal and State Exchanges, including the Small 
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Business Health Options Program Exchanges (com-
monly referred to as the ‘SHOP Exchanges’). 
‘‘(2) ELIGIBILITY.— 
‘‘(A) IN GENERAL.—Any individual who is 
a resident of the United States, as determined 
by the Secretary under subparagraph (C), and 
who is not an individual described in subpara-
graph (B), is eligible to enroll in a Medicare 
part E plan. 
‘‘(B) EXCLUSIONS.—An individual de-
scribed in this subparagraph is any individual 
who is— 
‘‘(i) entitled to, or enrolled for, bene-
fits under title XVIII; 
‘‘(ii) eligible for medical assistance 
under a State plan under title XIX; or 
‘‘(iii) enrolled for child health assist-
ance or pregnancy-related assistance under 
a State plan under title XXI. 
‘‘(C) REGULATIONS.—The Secretary shall 
promulgate a rule for determining residency for 
purposes of subparagraph (A). 
‘‘(3) EMPLOYER-SPONSORED PLANS.— 
‘‘(A) EMPLOYER ENROLLMENT.—Effective 
with respect to the first plan year that begins 
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1 year after the date of enactment of the 
Choose Medicare Act and each plan year there-
after, the Secretary shall provide options for 
Medicare part E plans in the small group mar-
ket and large group market that are voluntary, 
and available to all employers. 
‘‘(B) GROUP
HEALTH
PLANS.—The Sec-
retary, acting through the Administrator for the 
Centers for Medicare & Medicaid Services, at 
the request of a plan sponsor, shall serve as a 
third party administrator of a group health 
plan that is a Medicare part E plan offered by 
such sponsor. 
‘‘(C) PORTABILITY FOR EMPLOYER-SPON-
SORED PLANS.—The Secretary shall develop a 
process for allowing individuals enrolled in a 
Medicare part E plan offered in the small group 
market or large group market to maintain 
health insurance coverage through a Medicare 
part E plan if the individual subsequently loses 
eligibility for enrollment in such a plan based 
on termination of the employment relationship. 
The ability to maintain such coverage shall 
exist regardless of whether the individual has 
the option to enroll in other health insurance 
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coverage, including coverage offered in the indi-
vidual market or through a subsequent em-
ployer. 
‘‘(d) PREMIUMS.—The Secretary shall establish pre-
mium rates for the Medicare part E plans that— 
‘‘(1) are adjusted based on— 
‘‘(A) whether the plan is offered in the in-
dividual market, small group market, or large 
group market; and 
‘‘(B) the applicable rating area; 
‘‘(2) are at a level sufficient to fully finance— 
‘‘(A) the costs of health benefits provided 
by such plans; and 
‘‘(B) administrative costs related to oper-
ating the plans; and 
‘‘(3) comply with the requirements under sec-
tion 2701 of the Public Health Service Act (42 
U.S.C. 300gg), including for such plans that are of-
fered in the large group market. 
‘‘(e) PROVIDERS AND REIMBURSEMENT RATES.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a rate schedule for reimbursing types of health 
care providers furnishing items and services under 
the Medicare part E plans at rates that are con-
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sistent with the negotiations described in paragraph 
(2) and are necessary to maintain network adequacy. 
‘‘(2) MANNER
OF
NEGOTIATION.—The Sec-
retary shall negotiate the rates described in para-
graph (1) in a manner that results in payment rates 
that are not lower, in the aggregate, than rates 
under title XVIII, and not higher, in the aggregate, 
than the average rates paid by other health insur-
ance issuers offering health insurance coverage 
through an Exchange. 
‘‘(3) PARTICIPATING PROVIDERS.— 
‘‘(A) IN GENERAL.—A health care provider 
that is a participating provider of services or 
supplier under the Medicare program under 
title XVIII on the date of enactment of the 
Choose Medicare Act shall be a participating 
provider for Medicare part E plans. 
‘‘(B) ADDITIONAL PROVIDERS.—The Sec-
retary shall establish a process to allow health 
care providers not described in subparagraph 
(A) to become participating providers for Medi-
care part E plans. 
‘‘(4) LIMITATIONS ON BALANCE BILLING.—The 
limitations on balance billing pursuant to the provi-
sions of section 1866(a)(1)(A) shall apply to partici-
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pating providers for Medicare part E plans in the 
same manner as such provisions apply to partici-
pating providers under the Medicare program. 
‘‘(f) ENCOURAGING USE OF ALTERNATIVE PAYMENT 
MODELS.—The Secretary shall, as applicable, utilize alter-
native payment models, including those described in sec-
tion 1833(z)(3)(C), in making payments for items and 
services (including prescription drugs) furnished under 
Medicare part E plans. The payment rates under such al-
ternative payment models shall comply with the require-
ment for negotiated rates under subsection (e)(2). 
‘‘(g) PRESCRIPTION DRUGS.—The Secretary shall 
apply the provisions of part E of title XI to prescription 
drugs under Medicare part E plans in the same manner 
as such provisions apply with respect to selected drugs 
under part E of title XI. 
‘‘(h) APPROPRIATIONS.— 
‘‘(1) START UP FUNDING.—For purposes of es-
tablishing the Medicare part E plans, there is appro-
priated to the Secretary, out of any funds in the 
Treasury not otherwise obligated, $2,000,000,000, 
for fiscal year 2026. 
‘‘(2) INITIAL
RESERVES.—There is appro-
priated to the Secretary, out of any funds in the 
Treasury not otherwise obligated, such sums as may 
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be necessary, based on projected enrollment in the 
Medicare part E plans in the first plan year in 
which such plans are offered, to provide reserves for 
the purpose of paying claims filed during the initial 
90-day period of such plan year. 
‘‘(3) CLARIFICATION.—Any provision of law re-
stricting the use of Federal funds with respect to 
any reproductive health service shall not apply to 
funds appropriated under paragraph (1) or (2). 
‘‘(i) HEALTH INSURANCE ISSUER.—With respect to 
any Medicare part E plan, the Secretary shall be consid-
ered a health insurance issuer, within the meaning of sec-
tion 2791(b) of the Public Health Service Act (42 U.S.C. 
300gg–91(b)).’’. 
(b) APPLICATION OF EXCISE TAX FOR NONCOMPLI-
ANCE
WITH
NEGOTIATION
REQUIREMENTS.—Section 
5000D(e)(1) of the Internal Revenue Code of 1986 is 
amended by adding at the end the following new sentence: 
‘‘Such term shall apply to any drug treated in the same 
manner as a drug described in the preceding sentence by 
reason of section 2201(g) of the Social Security Act.’’. 
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SEC. 3. NOTICE AND NAVIGATOR REFERRAL FOR EMPLOY-
EES UNDER THE FAIR LABOR STANDARDS 
ACT OF 1938. 
(a) IN GENERAL.—Section 18B of the Fair Labor 
Standards Act of 1938 (29 U.S.C. 218b) is amended— 
(1) in the heading, by striking ‘‘TO’’ and insert-
ing ‘‘AND NAVIGATOR REFERRAL FOR’’; 
(2) by redesignating subsection (b) as sub-
section (c); 
(3) by inserting after subsection (a) the fol-
lowing: 
‘‘(b) NAVIGATOR REFERRAL.— 
‘‘(1) IN GENERAL.—An employer described in 
paragraph (3) shall refer each employee who is a 
full-time employee (as defined in section 4980H(c) 
of the Internal Revenue Code of 1986) to— 
‘‘(A) an entity that serves as a navigator 
under section 1311(i) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18031(i)) 
for the Exchange operating in the State of the 
employer; or 
‘‘(B) if the Exchange operating in the 
State of the employer does not have an entity 
serving as such a navigator, another entity that 
shall carry out equivalent activities as such a 
navigator. 
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‘‘(2) REFERRAL.—The referral described in 
paragraph (1) shall occur— 
‘‘(A) at the time the employer hires the 
employee; or 
‘‘(B) on the effective date described in sub-
section (c)(2) with respect to an employee who 
is currently employed by the employer on such 
date. 
‘‘(3) EMPLOYER.—An employer described in 
this paragraph is any employer that— 
‘‘(A) does not provide an eligible employer- 
sponsored 
plan 
as 
defined 
in 
section 
5000A(f)(2) of the Internal Revenue Code of 
1986; or 
‘‘(B) provides such an eligible employer- 
sponsored plan, but the plan is determined— 
‘‘(i) to be unaffordable to the em-
ployee 
under 
clause 
(i) 
of 
section 
36B(c)(2)(C) of such Code; or 
‘‘(ii) to not provide the required min-
imum value under clause (ii) of such sec-
tion.’’; and 
(4) in subsection (c), as so redesignated— 
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(A) in the heading, by striking ‘‘EFFEC-
TIVE
DATE’’ 
and 
inserting 
‘‘EFFECTIVE 
DATES’’; 
(B) by striking ‘‘Subsection (a)’’ and in-
serting the following: 
‘‘(1) NOTICE.—Subsection (a)’’; and 
(C) by adding at the end the following: 
‘‘(2) NAVIGATOR
REFERRAL.—Subsection (b) 
shall take effect with respect to employers in a State 
beginning on the date that is 2 years after the date 
of enactment of the Choose Medicare Act.’’. 
(b) STUDY.—Not later than January 1, 2030, the 
Comptroller General of the United States shall conduct 
a study on the impact of the requirements under section 
18B of the Fair Labor Standards Act of 1938 (29 U.S.C. 
218b), including the amendments made by subsection (a), 
on the rate of individuals without minimum essential cov-
erage as defined in section 5000A(f) of the Internal Rev-
enue Code of 1986 in the United States and in each State. 
(c) FUNDING FOR NAVIGATOR PROGRAM.—Section 
1311(i)(6) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18031(i)(6)) is amended— 
(1) by striking ‘‘Grants’’ and inserting the fol-
lowing: 
‘‘(A) IN GENERAL.—Grants’’; and 
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(2) by adding at the end the following: 
‘‘(B) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—There is authorized to be appropriated 
such sums as may be necessary to address ca-
pacity limitations of entities serving as naviga-
tors through a grant under this subsection.’’. 
SEC. 4. PROTECTING AGAINST HIGH OUT-OF-POCKET EX-
PENDITURES FOR MEDICARE FEE-FOR-SERV-
ICE BENEFITS. 
Title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) is amended by adding at the end the fol-
lowing new section: 
‘‘PROTECTION AGAINST HIGH OUT-OF-POCKET 
EXPENDITURES 
‘‘SEC. 1899C. (a) IN GENERAL.—Notwithstanding 
any other provision of this title, in the case of an indi-
vidual entitled to, or enrolled for, benefits under part A 
or enrolled in part B, if the amount of the out-of-pocket 
cost-sharing of such individual for a year (beginning with 
2027) equals or exceeds the annual out-of-pocket limit 
under subsection (b) for that year, the individual shall not 
be responsible for additional out-of-pocket cost-sharing in-
curred during that year. 
‘‘(b) ANNUAL OUT-OF-POCKET LIMIT.— 
‘‘(1) IN GENERAL.—The amount of the annual 
out-of-pocket limit under this subsection shall be— 
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‘‘(A) for 2027, $6,700; or 
‘‘(B) for a subsequent year, the amount 
specified in this subsection for the preceding 
year increased or decreased by the percentage 
change in the medical care component of the 
Consumer Price Index for All Urban Con-
sumers for the 12-month period ending with 
June of such preceding year. 
‘‘(2) ROUNDING.—If any amount determined 
under paragraph (1)(B) is not a multiple of $5, such 
amount shall be rounded to the nearest multiple of 
$5. 
‘‘(c) OUT-OF-POCKET COST-SHARING DEFINED.— 
‘‘(1) IN GENERAL.—Subject to paragraphs (2) 
and (3), in this section, the term ‘out-of-pocket cost- 
sharing’ means, with respect to an individual, the 
amount of the expenses incurred by the individual 
that are attributable to— 
‘‘(A) deductibles, coinsurance, and copay-
ments applicable under part A or B; or 
‘‘(B) for items and services that would 
have otherwise been covered under part A or B 
but for the exhaustion of those benefits. 
‘‘(2) CERTAIN COSTS NOT INCLUDED.— 
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‘‘(A) NON-COVERED
ITEMS
AND
SERV-
ICES.—Expenses incurred for items and serv-
ices which are not covered under part A or B 
shall not be considered incurred expenses for 
purposes of determining out-of-pocket cost- 
sharing under paragraph (1). 
‘‘(B) ITEMS
AND
SERVICES
NOT
FUR-
NISHED ON AN ASSIGNMENT-RELATED BASIS.— 
If an item or service is furnished to an indi-
vidual under this title and is not furnished on 
an assignment-related basis, any additional ex-
penses the individual incurs above the amount 
the individual would have incurred if the item 
or service was furnished on an assignment-re-
lated basis shall not be considered incurred ex-
penses for purposes of determining out-of-pock-
et cost-sharing under paragraph (1). 
‘‘(3) SOURCE OF PAYMENT.—For purposes of 
paragraph (1), the Secretary shall consider expenses 
to be incurred by the individual without regard to 
whether the individual or another person, including 
a State program, an employer, a medicare supple-
mental policy, or other third-party coverage, has 
paid for such expenses. 
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‘‘(d) ANNOUNCEMENT
OF
THE ANNUAL OUT-OF- 
POCKET LIMIT.—The Secretary shall (beginning in 2026) 
announce (in a manner intended to provide notice to all 
interested parties) the annual out-of-pocket limit under 
this section that will be applicable for the succeeding 
year.’’. 
SEC. 5. ENHANCEMENT OF PREMIUM ASSISTANCE CREDIT. 
(a) USE OF GOLD LEVEL PLAN FOR BENCHMARK.— 
(1) 
IN
GENERAL.—Clause 
(i) 
of 
section 
36B(b)(2)(B) of the Internal Revenue Code of 1986 
is amended by striking ‘‘applicable second lowest 
cost silver plan’’ and inserting ‘‘applicable second 
lowest cost gold plan’’. 
(2) CONFORMING
AMENDMENT
RELATED
TO 
AFFORDABILITY.—Section 
36B(c)(4)(C)(i)(I) 
of 
such Code is amended by striking ‘‘second lowest 
cost silver plan’’ and inserting ‘‘second lowest cost 
gold plan’’. 
(3) OTHER CONFORMING AMENDMENTS.—Sub-
paragraphs (B) and (C) of section 36B(b)(3) of such 
Code are each amended by striking ‘‘silver plan’’ 
each place it appears in the text and the heading 
and inserting ‘‘gold plan’’. 
(b) 
PERMANENT
EXTENSION
OF
ELIGIBILITY 
RULES.— 
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(1) IN GENERAL.—Section 36B(c)(1) of the In-
ternal Revenue Code of 1986 is amended— 
(A) in subparagraph (A), by striking ‘‘but 
does not exceed 400 percent’’, and 
(B) by striking subparagraph (E). 
(2) DETERMINATION OF APPLICABLE PERCENT-
AGE.—Subparagraph (A) of section 36B(b)(3) of 
such Code is amended by striking all that precedes 
the table in clause (iii)(II) and inserting the fol-
lowing: 
‘‘(A) 
APPLICABLE
PERCENTAGE.—For 
purposes of paragraph (2), except as provided 
in clause (ii), the applicable percentage for any 
taxable year shall be the percentage such that 
the applicable percentage for any taxpayer 
whose household income is within an income 
tier specified in the following table shall in-
crease, on a sliding scale in a linear manner, 
from the initial premium percentage to the final 
premium percentage specified in such table for 
such income tier:’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2025. 
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SEC. 6. ENHANCEMENTS FOR REDUCED COST SHARING. 
(a) DEFINITION OF ELIGIBLE INDIVIDUAL.—Section 
1402(b)(1) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18071(b)(1)) is amended by striking ‘‘sil-
ver level’’ and inserting ‘‘gold level’’. 
(b) MODIFICATION OF AMOUNT.— 
(1) IN
GENERAL.—Section 1402(c)(2) of the 
Patient Protection and Affordable Care Act is 
amended to read as follows: 
‘‘(2) ADDITIONAL REDUCTION.—The Secretary 
shall establish procedures under which the issuer of 
a qualified health plan to which this section applies 
shall further reduce cost-sharing under the plan in 
a manner sufficient to— 
‘‘(A) in the case of an eligible insured 
whose household income is not less than 100 
percent but not more than 133 percent of the 
poverty line for a family of the size involved, in-
crease the plan’s share of the total allowed 
costs of benefits provided under the plan to 94 
percent of such costs; 
‘‘(B) in the case of an eligible insured 
whose household income is more than 133 per-
cent but not more than 150 percent of the pov-
erty line for a family of the size involved, in-
crease the plan’s share of the total allowed 
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costs of benefits provided under the plan to 92 
percent of such costs; 
‘‘(C) in the case of an eligible insured 
whose household income is more than 150 per-
cent but not more than 200 percent of the pov-
erty line for a family of the size involved, in-
crease the plan’s share of the total allowed 
costs of benefits provided under the plan to 90 
percent of such costs; 
‘‘(D) in the case of an eligible insured 
whose household income is more than 200 per-
cent but not more than 300 percent of the pov-
erty line for a family of the size involved, in-
crease the plan’s share of the total allowed 
costs of benefits provided under the plan to 85 
percent of such costs; and 
‘‘(E) in the case of an eligible insured 
whose household income is more than 300 per-
cent but not more than 400 percent of the pov-
erty line for a family of the size involved, in-
crease the plan’s share of the total allowed 
costs of benefits provided under the plan to 80 
percent of such costs.’’. 
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(2) CONFORMING AMENDMENT.—Clause (i) of 
section 1402(c)(1)(B) of such Act is amended to 
read as follows: 
‘‘(i) IN
GENERAL.—The Secretary 
shall ensure the reduction under this para-
graph shall not result in an increase in the 
plan’s share of the total allowed costs of 
benefits provided under the plan above— 
‘‘(I) 94 percent in the case of an 
eligible insured described in para-
graph (2)(A); 
‘‘(II) 92 percent in the case of an 
eligible insured described in para-
graph (2)(B); 
‘‘(III) 90 percent in the case of 
an eligible insured described in para-
graph (2)(C); 
‘‘(IV) 85 percent in the case of 
an eligible insured described in para-
graph (2)(D); and 
‘‘(V) 80 percent in the case of an 
eligible insured described in para-
graph (2)(E).’’. 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to plan years beginning after De-
cember 31, 2025. 
SEC. 7. REINSURANCE AND AFFORDABILITY FUND. 
Part 5 of subtitle D of title I of the Patient Protec-
tion and Affordable Care Act is amended by inserting 
after section 1341 (42 U.S.C. 18061) the following: 
‘‘SEC. 1341A. REINSURANCE AND AFFORDABILITY FUND 
FOR THE INDIVIDUAL MARKET IN EACH 
STATE. 
‘‘(a) IN GENERAL.—The Secretary, in consultation 
with the National Association of Insurance Commis-
sioners, shall establish a program to enable each State, 
for any plan year beginning in the 3-year period beginning 
January 1, 2026, to— 
‘‘(1) provide reinsurance payments to health in-
surance issuers with respect to individuals enrolled 
under individual health insurance coverage offered 
by such issuers; or 
‘‘(2) provide assistance (other than through 
payments described in paragraph (1)) to reduce out- 
of-pocket costs, such as copayments, coinsurance, 
premiums, and deductibles, of individuals enrolled 
under qualified health plans offered in the individual 
market through an Exchange. 
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‘‘(b) APPROPRIATIONS.—There is appropriated, out 
of any money in the Treasury not otherwise appropriated, 
$30,000,000,000 for the period of fiscal years 2026 to 
2028 for purposes of establishing and administering the 
program established under this section. Such amount shall 
remain available until expended.’’. 
SEC. 8. EXPANDING RATING RULES TO LARGE GROUP MAR-
KET. 
(a) IN GENERAL.—Section 2701(a) of the Public 
Health Service Act (42 U.S.C. 300gg(a)) is amended— 
(1) in paragraph (1), by striking ‘‘small’’; and 
(2) by striking paragraph (5). 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to plans offered in the first plan 
year beginning after the date of enactment of this Act and 
any plan year thereafter. 
SEC. 9. PROTECTION OF CONSUMERS FROM EXCESSIVE, 
UNJUSTIFIED, OR UNFAIRLY DISCRIMINA-
TORY RATES. 
(a) PROTECTION FROM EXCESSIVE, UNJUSTIFIED, 
OR UNFAIRLY DISCRIMINATORY RATES.—Section 2794 of 
the Public Health Service Act (42 U.S.C. 300gg–94) is 
amended by adding at the end the following new sub-
section: 
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‘‘(e) PROTECTION FROM EXCESSIVE, UNJUSTIFIED, 
OR UNFAIRLY DISCRIMINATORY RATES.— 
‘‘(1) AUTHORITY OF STATES.—Nothing in this 
section shall be construed to prohibit a State from 
imposing requirements (including requirements re-
lating to rate review standards and procedures and 
information reporting) on health insurance issuers 
with respect to rates that are in addition to the re-
quirements of this section and are more protective of 
consumers than such requirements. 
‘‘(2) CONSULTATION
IN
RATE
REVIEW
PROC-
ESS.—In carrying out this section, the Secretary 
shall consult with the National Association of Insur-
ance Commissioners and consumer groups. 
‘‘(3) DETERMINATION OF WHO CONDUCTS RE-
VIEWS FOR EACH STATE.—The Secretary shall de-
termine, after the date of enactment of this sub-
section and periodically thereafter, the following: 
‘‘(A) In which markets in each State the 
State insurance commissioner or relevant State 
regulator shall undertake the corrective actions 
under paragraph (4), based on the Secretary’s 
determination that the State insurance commis-
sioner or relevant State regulator is adequately 
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undertaking and utilizing such actions in that 
market. 
‘‘(B) In which markets in each State the 
Secretary shall undertake the corrective actions 
under paragraph (4), in cooperation with the 
relevant State insurance commissioner or State 
regulator, based on the Secretary’s determina-
tion that the State is not adequately under-
taking and utilizing such actions in that mar-
ket. 
‘‘(4) CORRECTIVE ACTION FOR EXCESSIVE, UN-
JUSTIFIED, 
OR
UNFAIRLY
DISCRIMINATORY 
RATES.—In accordance with the process established 
under this section, the Secretary or the relevant 
State insurance commissioner or State regulator 
shall take corrective actions to ensure that any ex-
cessive, unjustified, or unfairly discriminatory rates 
are corrected prior to implementation, or as soon as 
possible thereafter, through mechanisms such as— 
‘‘(A) denying rates; 
‘‘(B) modifying rates; or 
‘‘(C) requiring rebates to consumers. 
‘‘(5) NONCOMPLIANCE.— 
‘‘(A) IN
GENERAL.—Failure to comply 
with any corrective action taken by the Sec-
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retary under this subsection may result in the 
application of civil monetary penalties described 
in subparagraph (B) and, if the Secretary de-
termines appropriate, make the plan involved 
ineligible for classification as a qualified health 
plan. 
‘‘(B) CIVIL MONETARY PENALTIES.— 
‘‘(i) IN GENERAL.—The provisions of 
section 1128A of the Social Security Act, 
other than subsection (a) and (b) and the 
first sentence of subsection (c)(1) of such 
section, shall apply to civil monetary pen-
alties under this paragraph in the same 
manner as such provisions apply to a pen-
alty or proceeding under section 1128A of 
the Social Security Act. 
‘‘(ii) AMOUNT.—The provisions of 
subparagraph (C) of section 2723(b)(2) 
shall apply to civil monetary penalties 
under this paragraph in the same manner 
as such provisions apply to a penalty under 
such section.’’. 
(b) CLARIFICATION OF REGULATORY AUTHORITY.— 
Section 2794 of the Public Health Service Act (42 U.S.C. 
300gg–94) is further amended— 
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(1) in subsection (a)— 
(A) in the subsection heading, by striking 
‘‘PREMIUM’’ and inserting ‘‘RATE’’; 
(B) in paragraph (1), by striking ‘‘unrea-
sonable increases in premiums’’ and inserting 
‘‘potentially excessive, unjustified, or unfairly 
discriminatory rates, including premiums,’’; and 
(C) in paragraph (2)— 
(i) by striking ‘‘an unreasonable pre-
mium increase’’ and inserting ‘‘a poten-
tially excessive, unjustified, or unfairly dis-
criminatory rate’’; 
(ii) by striking ‘‘the increase’’ and in-
serting ‘‘the rate’’; and 
(iii) by striking ‘‘such increases’’ and 
inserting ‘‘such rates’’; and 
(2) in subsection (b)— 
(A) in the subsection heading, by striking 
‘‘PREMIUM’’ and inserting ‘‘RATE’’; 
(B) by striking ‘‘premium increases’’ each 
place it appears and inserting ‘‘rates’’; 
(C) in paragraph (1)— 
(i) in the paragraph heading, by strik-
ing ‘‘PREMIUM
INCREASE’’ and inserting 
‘‘RATE’’; and 
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(ii) in subparagraph (B), by striking 
‘‘excessive or unjustified’’ and inserting 
‘‘excessive, unjustified, or unfairly discrimi-
natory’’; and 
(D) in paragraph (2)— 
(i) in the paragraph heading, by strik-
ing ‘‘PREMIUM INCREASES’’ and inserting 
‘‘RATES’’; and 
(ii) in subparagraph (B), by striking 
‘‘premium’’ and inserting ‘‘rate’’. 
(c) CONFORMING AMENDMENT.—Section 1311(e)(2) 
of the Patient Protection and Affordable Care Act (42 
U.S.C. 18031(e)(2)) is amended by striking ‘‘excessive or 
unjustified premium increases’’ and inserting ‘‘excessive, 
unjustified, or unfairly discriminatory rates’’. 
(d) APPLICABILITY TO GRANDFATHERED HEALTH 
PLANS.—Section 1251(a)(5) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18011(a)(5)) is 
amended— 
(1) by striking ‘‘Sections 2799A–1’’ and insert-
ing the following: 
‘‘(A) IN
GENERAL.—Sections 2799A–1’’; 
and 
(2) by adding at the end the following: 
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‘‘(B) ENSURING
THAT
CONSUMERS
GET 
VALUE FOR THEIR DOLLARS.—Section 2794 of 
the Public Health Service Act shall apply to 
grandfathered health plans for plan years be-
ginning on or after January 1, 2026.’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of enactment of 
this Act and shall be implemented with respect to health 
plans beginning not later than January 1, 2026. 
SEC. 10. SENSE OF CONGRESS. 
It is the sense of the Congress that— 
(1) the Federal Government, acting in its ca-
pacity as an insurer, employer, or health care pro-
vider, should serve as a model for the Nation to en-
sure coverage of all reproductive services; and 
(2) all restrictions on coverage of reproductive 
services in the private insurance market should end. 
Æ 
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