Affordable CHOICE Act
Sponsored By: Senator Whitehouse, Sheldon [D-RI]
Introduced
Summary
Creates a federal public health insurance option (PHIO) offered through the ACA Exchanges. It would be run by the Secretary and designed to expand choice, prioritize affordability and access, and set premium and provider payment rules for nationwide coverage.
Show full summary
- Families and consumers: Would add a Secretary-run plan sold on Exchanges in bronze, silver, and gold levels and subject to Exchange consumer protections to expand choice and aim to lower costs.
- Health care providers: Would make providers already in Medicare or Medicaid eligible to participate unless they opt out. The Secretary would negotiate payment rates by Jan 1, 2026 and default to original Medicare Parts A and B rates if negotiations fail.
- States and federal finance: Would fund benefits with geographically adjusted premiums set to fully finance benefits and administrative costs, establish a PHIO Treasury account, authorize start-up appropriations that include funds to cover 90 days of claims reserves, and require repayment of start-up funding over 10 years.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 2 benefits, 0 costs, 2 mixed.
New Public Option on Exchanges
If enacted, the bill would create a new Public Health Insurance Option the Secretary would offer only on ACA Exchanges for plan years starting January 1, 2027. The option would be offered nationwide and include bronze, silver, and gold plans. The Secretary would administer the option and design it to be affordable without reducing quality or access. The bill would add the option to the ACA's definition of a qualified health plan so it would be treated like other Exchange plans.
Provider payment and participation rules
If enacted, the Secretary would negotiate Public Option payment rates with providers and drug suppliers by January 1, 2026. If no negotiated agreement is reached, payments would default to original Medicare fee-for-service rates, with adjustments for services or drugs Medicare does not cover. The bill would make providers who participate in Medicare or a State Medicaid plan participating in the Public Option unless they opt out, and it would set a process for other providers to join. These rules could lower payments for the plan but also affect doctor and hospital participation and access.
Public Option premiums and funding
If enacted, the Secretary would set Public Option premiums by area to fully cover benefits, administrative costs, and an appropriate contingency margin. Premium variation would be limited to what the Public Health Service Act allows. The Secretary would collect data to set premiums and provider rates and to help reduce health disparities. The bill would also create a Treasury account, authorize appropriations for startup costs and 90 days of claims reserves, and require startup funds be repaid over 10 years starting January 1, 2027.
State advisory councils and contractors
If enacted, the Secretary could hire contractors to run administrative parts of the Public Option but would not be allowed to transfer insurance risk to them. States could set up public or nonprofit advisory councils with consumers and providers to advise the Secretary on quality, cost control, outreach, and alternative payment models. The Secretary could use a council's recommendations in that State, in other States, or nationally.
Sponsors & CoSponsors
Sponsor
Whitehouse, Sheldon [D-RI]
RI • D
Cosponsors
Elissa Slotkin
MI • D
Sponsored 1/8/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov