No official summary available for this bill.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 3369 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 3369
To establish a public health plan.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 4, 2025
Mr. Bennet (for himself, Mr. Kaine, Mr. Booker, Ms. Duckworth, Ms.
Smith, Mr. Warnock, Mr. Hickenlooper, and Ms. Klobuchar) introduced the
following bill; which was read twice and referred to the Committee on
Finance
_______________________________________________________________________
A BILL
To establish a public health plan.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare-X Choice Act of 2025''.
SEC. 2. ESTABLISHMENT AND ADMINISTRATION OF A PUBLIC HEALTH PLAN.
The Social Security Act is amended by adding at the end the
following new title:
``TITLE XXII--MEDICARE EXCHANGE HEALTH PLAN
``SEC. 2201. ESTABLISHMENT.
``(a) Establishment of Plan.--
``(1) In general.--The Secretary shall establish a
coordinated and low-cost health plan, to be known as the
`Medicare Exchange health plan' (referred to in this section as
the `health plan') to provide access to quality health care for
enrollees.
``(2) Timeframe.--
``(A) Individual market availability.--The
Secretary shall make the health plan available in the
individual market, in all rating areas, for plan year
2028 and each subsequent plan year.
``(B) Small group market.--The Secretary shall make
the health plan available in the small group market, in
all rating areas, for plan year 2028 and each
subsequent plan year.
``(b) Establishment of Funds.--
``(1) Plan reserve fund.--
``(A) In general.--There is established in the
Treasury of the United States a `Plan Reserve Fund', to
be administered by the Secretary of Health and Human
Services, for purposes of establishing the Medicare
Exchange health plan and administering such plan,
consisting of amounts appropriated to such fund during
the period of fiscal years 2027 through 2036.
``(B) Appropriation.--There is appropriated
$1,000,000,000, out of monies in the Treasury not
otherwise obligated, to the Plan Reserve Fund for
fiscal year 2027, to remain available until expended.
``(2) Data and technology fund.--
``(A) In general.--There is established in the
Treasury of the United States a `Data and Technology
Fund', to be administered by the Secretary of Health
and Human Services, acting through the Chief Actuary of
the Centers for Medicare & Medicaid Services, for
purposes of updating technology and performing data
collection under section 2205 in order to establish
appropriate premiums for all geographic regions of the
United States, consisting of amounts appropriated to
such fund during the period of fiscal years 2027
through 2036.
``(B) Appropriation.--There is appropriated
$1,000,000,000, out of amounts in the Treasury not
otherwise appropriated, to the Data and Technology Fund
for fiscal year 2027, to remain available until
expended.
``(c) Rulemaking.--Not later than 180 days after the date of
enactment of the Medicare-X Choice Act of 2025, the Secretary shall
promulgate such regulations as may be necessary to carry out this
title. Rules promulgated under this subsection shall be finalized not
later than 270 days after the date of enactment of the Medicare-X
Choice Act of 2025.
``SEC. 2202. AVAILABILITY OF PLAN.
``(a) Eligibility.--An individual shall be eligible to enroll in
the health plan if such individual, for the entire period for which
enrollment is sought--
``(1) is a qualified individual within the meaning of
section 1312 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18032); and
``(2) is not eligible for benefits under the Medicare
program under title XVIII.
``(b) Exchanges.--In accordance with the timeframe under section
2201(a)(2), the health plan shall be made available through the
American Health Benefit Exchanges described in sections 1311 and 1321
of the Patient Protection and Affordable Care Act (42 U.S.C. 18031,
18041), including the Small Business Health Options Program Exchange.
``SEC. 2203. PLAN REQUIREMENTS.
``(a) General Requirements.--The health plan shall comply with all
requirements, as applicable, of subtitle D of title I of the Patient
Protection and Affordable Care Act and title XXVII of the Public Health
Service Act applicable to qualified health plans, and such health plan
shall be a qualified health plan, including for purposes of the
Internal Revenue Code of 1986.
``(b) Levels of Coverage.--The Secretary--
``(1) shall make available a silver level and gold level
version of the plan, in accordance with section
1301(a)(1)(C)(ii) of the Patient Protection and Affordable Care
Act; and
``(2) may make available no more than 2 versions of the
plan for each of the 4 levels of coverage described in
subparagraphs (A) through (D) of section 1302(d)(1) of the
Patient Protection and Affordable Care Act.
``(c) Primary Care Services.--The health plan shall provide
coverage for primary care services, and shall not impose any cost-
sharing requirements for such services.
``SEC. 2204. ADMINISTRATIVE CONTRACTING.
``(a) In General.--The Secretary may enter into contracts for the
purpose of performing administrative functions (including functions
described in subsection (a)(4) of section 1874A) with respect to the
health plan in the same manner as the Secretary may enter into
contracts under subsection (a)(1) of such section. The Secretary shall
have the same authority with respect to the public health insurance
option as the Secretary has under such subsection (a)(1) and subsection
(b) of section 1874A with respect to title XVIII.
``(b) Transfer of Insurance Risk.--Any contract under subsection
(a) shall not involve the transfer of insurance risk from the Secretary
to the entity entering into such contract with the Secretary, except in
the case of an alternative payment model under section 2209(h).
``SEC. 2205. DATA COLLECTION.
``Subject to all applicable privacy requirements, including the
requirements under the regulations promulgated pursuant to section
264(c) of the Health Insurance Portability and Accountability Act of
1996 (42 U.S.C. 1320d-2 note), the Secretary may collect data from
State insurance commissioners and other relevant entities to establish
rates for premiums and for other purposes, including to improve
quality, and reduce racial, ethnic, socioeconomic, geographic, gender,
sexual identity, and other health disparities, including such
disparities experienced by people with disabilities and older adults,
with respect to the health plan.
``SEC. 2206. PREMIUMS; RISK POOL.
``(a) Setting Premiums.--
``(1) In general.--The Secretary shall establish premiums
for the health plan that cover the full actuarial cost of
offering such plan, including the administrative costs of
offering such plan. Such premiums shall vary geographically and
between the small group market and the individual market in
accordance with differences in the cost of providing such
coverage. If, for any plan year, the amount collected in
premiums exceeds the amount required for health care benefits
and administrative costs in that plan year, such excess amounts
shall remain available to the Secretary to administer the
health plan and finance beneficiary costs in subsequent years.
``(2) Initial plan year.--For plan year 2028, the Secretary
shall set premiums for the health plan for each rating area in
which the health plan is available for such plan year, taking
into consideration the premium rates for plans offered in each
such rating area for plan year 2027.
``(b) Risk Pool.--After plan year 2028, all enrollees in the health
plan within a State shall be members of a single risk pool, except that
the Secretary may establish separate risk pools for the individual
market and small group market if the State has not exercised its
authority under section 1312(c)(3) of the Patient Protection and
Affordable Care Act.
``SEC. 2207. REIMBURSEMENT RATES.
``(a) Medicare Rates.--
``(1) In general.--Except as provided in paragraph (2) and
subsections (b) and (c) and subject to subsection (d), the
Secretary shall reimburse health care providers furnishing
items and services under the health plan at rates determined
for equivalent items and services under the original Medicare
fee-for-service program under parts A and B of title XVIII.
``(2) Authority to increase payments rates in rural
areas.--If the Secretary determines appropriate, the Secretary
may increase the reimbursements rates described in paragraph
(1) by up to 50 percent for items and services furnished in
rural areas (as defined in section 1886(d)(2)(D)).
``(b) Prescription Drugs.--Subject to subsection (d), payment rates
for prescription drugs shall be at a rate negotiated by the Secretary.
Such negotiations may be in conjunction with negotiations for selected
drugs under part E of title XI.
``(c) Additional Items and Services.--Subject to subsection (d),
the Secretary shall establish reimbursement rates for any items and
services provided under the health plan that are not items and services
provided under the original Medicare fee-for-service program under
parts A and B of title XVIII.
``(d) Innovative Payment Methods.--The Secretary may utilize
innovative payment methods, including value-based payment arrangements,
in making payments for items and services (including prescription
drugs) furnished under the health plan.
``(e) Comprehensive Study on Covering Additional Services.--
``(1) In general.--The Secretary, acting through the
Administrator of the Centers for Medicare & Medicaid Services,
shall conduct a comprehensive study, in consultation with
stakeholders, and develop recommendations for Congress on the
need for, and cost of providing coverage for, additional
services under the health plan.
``(2) Content.--The study shall under paragraph (1) shall
include--
``(A) consideration of providing coverage for long-
term services and supports, home and community based
services, assistive and enabling technologies, and
vision, hearing, and dental services;
``(B) consideration of providing coverage for other
services in addition to the services described in
subparagraph (A) that could most benefit the health and
financial well-being of beneficiaries, including by
reducing health disparities, if included for coverage
under the plan;
``(C) the costs associated with covering additional
services described in subparagraphs (A) and (B), for
beneficiaries through cost-sharing and premiums, and
for the Federal Government; and
``(D) an assessment of the implications of covering
such additional services for the risk pool of the
health plan and for the individual and small group
markets.
``(3) Submission of report.--Not later than 2 years after
the date of enactment of this title, the Secretary shall submit
to Congress a report on the findings and recommendations of the
study under this subsection and shall make such report publicly
available on the website of the Department of Health and Human
Services.
``SEC. 2208. PARTICIPATING PROVIDERS.
``(a) Requirement To Participate in Order To Be Enrolled Under
Medicare.--Subject to subsection (d), beginning January 1, 2028, a
health care provider may not be enrolled under the Medicare program
under section 1866(j) unless the provider is also a participating
provider under the health plan.
``(b) Requirement To Participate in Order To Participate in
Medicaid.--Subject to subsection (d), beginning January 1, 2028, a
health care provider may not be a participating provider under a State
Medicaid plan under title XIX (or a waiver of such a plan) unless the
provider is also a participating provider under the health plan.
``(c) Additional Providers.--The Secretary shall establish a
process to allow health care providers not described in subsection (a)
or (b) to become a participating provider under the health plan.
``(d) Opt-Out.--The Secretary shall establish a process by which a
health care provider described in subsection (a) or (b) may opt out of
being a participating provider under the health plan, under exceptional
circumstances where participation in the health plan threatens the
provider's ability to operate.
``SEC. 2209. DELIVERY SYSTEM REFORM FOR AN ENHANCED HEALTH PLAN.
``(a) In General.--For plan years beginning with plan year 2028,
the Secretary may utilize innovative payment mechanisms and policies to
determine payments for items and services under the health plan. The
payment mechanisms and policies under this section may include patient-
centered medical home and other care management payments, accountable
care organizations, accountable communities for health, value-based
purchasing, bundling of services, differential payment rates,
performance or utilization based payments, telehealth, remote patient
monitoring, partial capitation, and direct contracting with providers.
``(b) Requirements for Innovative Payments.--The Secretary shall
design and implement the payment mechanisms and policies under this
section in a manner that--
``(1) seeks to--
``(A) improve health outcomes;
``(B) reduce health disparities (including racial,
ethnic, socioeconomic, geographic, gender, sexual
identity, and other disparities, including such
disparities experienced by people with disabilities and
older adults);
``(C) improve coordination to provide more
efficient and affordable quality care;
``(D) address geographic variation in the provision
of health services; or
``(E) prevent or manage chronic illness;
``(2) promotes care that is integrated, patient-centered,
quality, and efficient;
``(3) implements patient feedback mechanisms, including
culturally- and disability-competent mechanisms; and
``(4) uses person-reported experiences to improve service
delivery.
``(c) Encouraging the Use of High-Value Services.--To the extent
allowed by the benefit standards applied to all health benefits plans
participating in the Exchanges (as described in section 2202(b)), the
health plan may modify cost-sharing and payment rates to encourage the
use of services that promote health and value.
``(d) Promotion of Delivery System Reform.--The Secretary shall
monitor and evaluate the progress of payment and delivery system
reforms under this section and shall seek to implement such reforms
subject to the following:
``(1) To the extent that the Secretary finds a payment and
delivery system reform successful in improving quality and
reducing costs, the Secretary shall implement such reform on as
large a geographic scale as practical and economical.
``(2) The Secretary may delay the implementation of such a
reform in geographic areas in which such implementation would
place the public health insurance option at a competitive
disadvantage.
``(3) The Secretary may prioritize implementation of such a
reform in high-cost geographic areas or otherwise in order to
reduce total program costs or to promote high-value care.
``(4) The Secretary may prioritize implementation of such a
reform to reduce racial, ethnic, socioeconomic, geographic,
gender, sexual identity, or other health disparities, including
such disparities experienced by people with disabilities or
older adults.
``(e) Non-Uniformity Permitted.--Nothing in this section shall
prevent the Secretary from varying payments based on different payment
structure models (such as accountable care organizations and medical
homes) under the health plan for different geographic areas.
``(f) Integration With Social Services.--
``(1) In general.--The Secretary shall establish processes
and, when appropriate, collaborate with other agencies to
integrate medical care under the health plan with food,
housing, transportation, and income assistance if the Secretary
determines that such integration is expected to--
``(A) reduce spending without reducing the quality
of patient care;
``(B) improve the quality of patient care without
increasing spending; or
``(C) reduce racial, ethnic, socioeconomic,
geographic, gender, sexual identity, or other health
disparities, including any such disparities experienced
by people with disabilities or older adults.
``(2) Authorization of a grant program.--
``(A) In general.--The Secretary may establish a
grant program to permit broader experimentation with
accountable communities for health model.
``(B) Eligible recipients.--The Secretary may award
a grant under this section to--
``(i) an institution of higher learning (as
defined in section 3452(f) of title 38, United
States Code);
``(ii) a local educational agency (as
defined in section 8101 of the Elementary and
Secondary Education Act of 1965);
``(iii) a health care agency;
``(iv) a nonprofit entity that the
Secretary determines has a demonstrated history
of community engagement; or
``(v) any other entity, as the Secretary
determines appropriate.
``(C) Use of funds.--A recipient of a grant under
this section may use the grant to--
``(i) support community needs assessment;
``(ii) establish social service
partnerships; or
``(iii) establish interactive data systems
across health and social service providers.
``(D) Authorization of appropriations.--There are
authorized to be appropriated such sums as may be
necessary to carry out this paragraph.
``(3) Regulations.--If the Secretary establishes a grant
program under this section, the Secretary shall promulgate
regulations on--
``(A) the evaluation of applications for grants
under the program; and
``(B) administration of the program.
``(g) Telehealth.--The Secretary shall ensure the integration of
telehealth tools, including technology-enabled collaborative learning
and capacity building models, that increase patient access to medical
care (including specialty care), particularly in remote or underserved
areas, if the Secretary determines that such integration is expected
to--
``(1) reduce spending without reducing the quality of
patient care; or
``(2) improve the quality of patient care without
increasing spending.
``(h) Alternative Payment Model.--
``(1) In general.--The Secretary shall evaluate the
possibility of providing incentives, and, if appropriate, apply
incentives, for enrollees in the health plan who receive
services from providers who are participating in an alternative
payment model (as defined in section 1833(z)(3)(C)).
``(2) Authority to use apms in use under traditional
medicare.--Nothing in this section shall preclude the Secretary
from using alternative payment models (as so defined) under
this title that are in use under title XVIII.
``SEC. 2210. NO EFFECT ON MEDICARE BENEFITS OR MEDICARE TRUST FUNDS.
``Nothing in this title shall--
``(1) affect the benefits available under title XVIII; or
``(2) impact the Federal Hospital Insurance Trust Fund
under section 1817 or the Federal Supplementary Medical
Insurance Trust Fund under section 1841 (including the Medicare
Prescription Drug Account within such Trust Fund).''.
SEC. 3. EXCLUSION OF PROVIDERS THAT PLACE ADDITIONAL RESTRICTIONS ON
MEDICARE EXCHANGE HEALTH PLAN PATIENTS FROM FEDERAL
HEALTH CARE PROGRAMS.
Section 1128(b) of the Social Security Act (42 U.S.C. 1320a-7(b))
is amended by adding at the end the following new paragraph:
``(18) Placement of restrictions on medicare exchange
health plan patients.--Any individual or entity that places
restrictions on the individuals the individual or provider will
accept for treatment and fails to either--
``(A) exempt enrollees in the Medicare Exchange
health plan established under title XXII from such
restrictions; or
``(B) apply such restrictions to enrollees in the
Medicare Exchange health plan in the same manner and to
the same extent the restrictions are applied to all
other individuals seeking care.''.
SEC. 4. REINSURANCE.
(a) In General.--The Secretary of Health and Human Services shall
establish a mechanism to pool, on a nationwide basis, the costs of the
highest-cost patients enrolled in individual health insurance coverage
(as defined in section 2791 of the Public Health Service Act (42 U.S.C.
300gg-91)) offered on or off the Exchanges, to the extent such costs
are not already pooled pursuant to section 1343 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18063), for the purpose
of reducing premiums for such individual health insurance coverage.
(b) Authorization of Appropriations.--For purposes of carrying out
paragraph (1), there is authorized to be appropriated $10,000,000,000
for each of fiscal years 2028, 2029, and 2030.
SEC. 5. EXPANSION OF TAX CREDIT.
(a) In General.--Subparagraph (A) of section 36B(c)(1) of the
Internal Revenue Code of 1986 is amended by striking ``but does not
exceed 400 percent''.
(b) Applicable Percentages.--Section 36B(b)(3)(A) of the Internal
Revenue Code of 1986 is amended to read as follows:
``(A) Applicable percentage.--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 increase, 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:
------------------------------------------------------------------------
The initial The final
``In the case of household income (expressed premium premium
as a percent of poverty line) within the percentage percentage
following income tier: is-- is--
------------------------------------------------------------------------
Up to 150 percent............................. 0 0
150 percent up to 200 percent................. 0 2.0
200 percent up to 250 percent................. 2.0 4.0
250 percent up to 300 percent................. 4.0 6.0
300 percent up to 400 percent................. 6.0 8.5
400 percent and up............................ 8.5 8.5.''.
------------------------------------------------------------------------
(c) Limitation on Recapture.--Clause (i) of section 36B(f)(2)(B) of
the Internal Revenue Code of 1986 is amended--
(1) by striking ``In the case of a taxpayer'' and all that
follows through ``the amount of the increase'' and inserting
``The amount of the increase'';
(2) by striking the period at the end of the last row of
the table; and
(3) by adding at the end of the table the following new
row:
------------------------------------------------------------------------
``400 percent and up....................................... $5,000.''.
------------------------------------------------------------------------
(d) Fixing the Family Glitch.--
(1) In general.--Clause (i) of section 36B(c)(2)(C) of the
Internal Revenue Code of 1986 is amended to read as follows:
``(i) Coverage must be affordable.--
``(I) Employees.--An employee shall
not be treated as eligible for minimum
essential coverage if such coverage
consists of an eligible employer-
sponsored plan (as defined in section
5000A(f)(2)) and the employee's
required contribution (within the
meaning of section 5000A(e)(1)(B)) with
respect to the plan exceeds 9.5 percent
of the employee's household income.
``(II) Family members.--An
individual who is eligible to enroll in
an eligible employer-sponsored plan (as
defined in section 5000A(f)(2)) by
reason of a relationship the individual
bears to the employee shall not be
treated as eligible for minimum
essential coverage by reason of such
eligibility to enroll if the employee's
required contribution (within the
meaning of section 5000A(e)(1)(B),
determined by substituting `family' for
`self-only') with respect to the plan
exceeds 9.5 percent of the employee's
household income.''.
(2) Conforming amendments.--
(A) Clause (ii) of section 36B(c)(2)(C) of the
Internal Revenue Code of 1986 is amended by striking
``Except as provided in clause (iii), an employee'' and
inserting ``An individual''.
(B) Clause (iii) of section 36B(c)(2)(C) of such
Code is amended by striking ``the last sentence of
clause (i)'' and inserting ``clause (i)(II)''.
(C) Clause (iv) of section 36B(c)(2)(C) of such
Code is amended by striking ``the 9.5 percent under
clause (i)(II)'' and inserting ``the 9.5 percent under
clauses (i)(I) and (i)(II)''.
(e) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2025.
SEC. 6. AUTHORITY TO NEGOTIATE FAIR PRICES FOR MEDICARE PRESCRIPTION
DRUGS.
(a) In General.--Section 1860D-11 of the Social Security Act (42
U.S.C. 1395w-111) is amended by striking subsection (i).
(b) Effective Date.--The amendment made by this section shall take
effect on the date of enactment of this Act.
SEC. 7. STRENGTHENING ANTITRUST ENFORCEMENT IN HEALTH CARE MARKETS.
There are authorized to be appropriated for the purpose of studying
health care markets, including anticompetitive practices within those
markets, and taking appropriate antitrust enforcement action for each
of fiscal years 2027 through 2031, to remain available until expended--
(1) $50,000,000 to the Antitrust Division of the Department
of Justice; and
(2) $100,000,000 to the Federal Trade Commission.
SEC. 8. REPORTS.
The Antitrust Division of the Department of Justice and the Federal
Trade Commission shall submit to Congress a report--
(1) not later than the date that is 1 year after the date
of enactment of this Act, detailing the activities on which the
Antitrust Division or the Commission spent funds authorized
under section 7; and
(2) not later than September 30, 2032, that includes--
(A) the findings of any study conducted by the
Antitrust Division or the Commission on or after the
date of enactment of this Act;
(B) the activities on which the Antitrust Division
or the Commission spent funds authorized under section
7; and
(C) the impact of any enforcement action taken on
or after the date of enactment of this Act by the
Antitrust Division or the Commission on improving
consumer access to affordable health care.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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