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S3599119th CongressWALLET

Affordable CHOICE Act

Sponsored By: Senator Whitehouse, Sheldon [D-RI]

Introduced

Summary

A federal public health insurance option would be offered through the ACA exchanges to expand affordable, high-quality choices and increase competition and stability in the individual and small-group markets. The option would be managed by the HHS Secretary and offered as bronze, silver, and gold qualified health plans for plan years beginning January 1, 2027.

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  • Families and consumers would get a new government-run plan on the exchanges that follows the same benefit levels, consumer protections, provider network rules, and cost-sharing limits as other qualified plans. This gives people another standardized choice at bronze, silver, and gold levels.
  • Health care providers would face new participation rules and payment negotiations. Medicare and Medicaid participating providers would be included unless they opt out, and the Secretary must negotiate rates by January 1, 2026, with default payment set to Medicare Parts A and B rates if talks fail.
  • States and the federal government would share design and oversight roles. States may form advisory councils to advise on operations and quality, while the Secretary would set premiums, collect data, and hold PHIO receipts and disbursements in a Treasury account. Start-up funding for 90 days of claims reserves is authorized, with repayment amortized over a 10-year period starting January 1, 2027.

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 3 benefits, 0 costs, 2 mixed.

New public plan on health Exchanges

If enacted, the federal government would offer a new public health plan through the ACA Exchanges starting with plan years that begin January 1, 2027. The plan would be sold only by the Secretary, not private insurers. It would include bronze, silver, and gold levels and be treated as a qualified health plan so existing Exchange rules and consumer protections apply.

Public plan startup funding and repayment

If enacted, the government would create a Treasury account for money and spending related to the public plan. The bill would authorize the funds needed to start the plan, including enough to cover 90 days of claims reserves based on projected enrollment. Any start-up funding would be repaid to the Treasury over a 10-year period beginning January 1, 2027. States would be barred from taxing those receipts.

Provider participation and contracting rules

If enacted, providers who participate in Medicare or a State Medicaid plan would be participating providers in the public plan by default unless they opt out through a Secretary-established process. The Secretary would set conditions of participation and require State licensure or certification. The Secretary could hire contractors for administrative work but could not transfer insurance risk to those contractors. The Secretary must also create a way for other providers to join.

Public plan premiums and provider payments

If enacted, the Secretary would set geographically adjusted premiums for the public plan for plan years starting January 1, 2027. Premiums must fully finance benefits, administrative costs, and include a contingency margin. The Secretary must negotiate provider and drug payment rates by January 1, 2026; if talks fail, payment would default to Medicare-equivalent rates (Parts A and B) adjusted for services or drugs Medicare does not cover. The Secretary would collect data to set rates and track quality and disparities.

State advisory councils for the public plan

If enacted, a State could create a public or nonprofit advisory council to give the Secretary recommendations about the public plan. Councils would include the public, consumers, and providers. They would advise on quality improvement, cost control, public outreach, and value-based payment ideas. The Secretary could apply a State council's recommendations in that State, other States, or nationwide.

Sponsors & CoSponsors

Sponsor

Whitehouse, Sheldon [D-RI]

RI • D

Cosponsors

  • Sen. Slotkin, Elissa [D-MI]

    MI • D

    Sponsored 1/8/2026

Roll Call Votes

No roll call votes available for this bill.

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