HR7023119th CongressWALLET

Affordable CHOICE Act

Sponsored By: Representative Schakowsky

Introduced

Summary

Public Health Insurance Option (PHIO). This bill would create a public health plan offered by the Secretary through the Exchanges to increase competition, affordability, and access for people buying coverage on the Exchange. It would begin for plan years starting January 1, 2027 and must follow Exchange rules for benefits, consumer protections, notices, and cost sharing.

Show full summary
  • Families and individual buyers would be able to choose a PHIO plan in bronze, silver, or gold tiers on the Exchanges starting in 2027. Premiums would be geographically adjusted to fully finance benefit and administrative costs and would be limited by existing premium variation rules.
  • Providers must meet state licensure or certification to participate and Medicare and Medicaid participating providers are automatically included unless they opt out. Provider payment rates must be negotiated by January 1, 2026 and, if negotiators do not agree, payments default to Medicare Part A and B levels.
  • States may create public or nonprofit advisory councils with consumers and providers to recommend PHIO policies on quality, cost containment, outreach, and payment models. The Secretary may apply those recommendations across States.

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Bill Overview

Analyzed Economic Effects

6 provisions identified: 3 benefits, 0 costs, 3 mixed.

New public option on Exchanges

If enacted, this bill would create a public health insurance option to sell on the ACA Exchanges for plan years that begin on or after January 1, 2027. The option would be offered by the federal Health Secretary, not private insurers. People and small employers who shop the Exchanges would be able to enroll in bronze, silver, or gold versions of the plan.

Default provider participation rules

If enacted, providers who participate in Medicare or a State Medicaid program would be treated as participating PHIO providers unless they opt out through a Secretary-established process. The Secretary would also set a way for other providers to join and would require appropriate State licensure or certification. These rules aim to enlarge available networks but allow providers to opt out and impose participation conditions.

Public option funding and admin contracts

If enacted, Congress could provide start-up money to establish the public option and to cover 90 days of claims reserves based on projected enrollment. The Secretary would set up an interest-bearing Treasury account for PHIO receipts and disbursements and must repay start-up funds amortized over 10 years beginning January 1, 2027. The Secretary could hire contractors for administrative tasks, but contracts could not transfer insurance risk to contractors and appropriations would be authorized for those contracts.

Public option premiums and provider rates

If enacted, the Secretary would set geographically adjusted PHIO premiums that must fully finance benefit and administrative costs and include a contingency margin. The Secretary would also negotiate provider reimbursement and prescription drug rates and must have rates established by January 1, 2026. If negotiations fail, Medicare fee-for-service rates would be used as a fallback, with allowed adjustments for items Medicare does not cover.

Public option follows Exchange rules

If enacted, the public option would have to follow the same Exchange and Public Health Service Act rules as other qualified plans. That includes rules on covered benefits, provider networks, notices, consumer protections, and cost-sharing. The public option would be treated as a qualified health plan under the ACA.

State advisory councils for public option

If enacted, States could set up public or nonprofit advisory councils to give recommendations on public option operations. Councils would include consumers and providers and could advise on quality, cost containment, outreach, and payment models. The Secretary could apply a State council's recommendations to the public option in that State, other States, or all States.

Sponsors & CoSponsors

Sponsor

Schakowsky

IL • D

Cosponsors

  • Cohen

    TN • D

    Sponsored 1/12/2026

  • Del. Norton, Eleanor Holmes [D-DC-At Large]

    DC • D

    Sponsored 1/12/2026

  • Rep. Johnson, Julie [D-TX-32]

    TX • D

    Sponsored 1/12/2026

  • Rep. Moore, Gwen [D-WI-4]

    WI • D

    Sponsored 1/12/2026

Roll Call Votes

No roll call votes available for this bill.

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