The CHOICE Act would establish a new public health insurance option to be offered through the Affordable Care Act's health insurance marketplaces starting in 2026. This government-run plan would offer bronze, silver, and gold coverage levels and would be available to individuals purchasing insurance on the exchanges alongside existing private plans. The Secretary of Health and Human Services would set premium rates based on geographic location and actual costs, negotiate payment rates with healthcare providers, and establish a federal account to manage the plan's finances. The bill authorizes funding for startup costs and a 90-day claims reserve, with startup costs to be repaid to the Treasury over ten years beginning in 2026. Most healthcare providers participating in Medicare and Medicaid would automatically participate in the public option unless they opt out, and states may establish advisory councils to provide recommendations on the plan's operations.
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