The CHOICE Act would establish a new government-run health insurance option to be offered through the Affordable Care Act's insurance marketplaces starting in 2026. This public plan would compete alongside private insurance options and be available to anyone eligible to purchase coverage on the exchanges, offering bronze, silver, and gold plan levels. The plan would be administered by the federal government with rates set to cover the full cost of benefits and administrative expenses, with healthcare provider payment rates either negotiated by the Secretary or defaulting to Medicare rates if negotiations fail. States could establish advisory councils to make recommendations on the plan's operations, and most Medicare and Medicaid providers would automatically participate unless they opt out. The legislation authorizes startup funding to establish the program and cover 90 days of claims, with this initial investment repaid to the Treasury over a 10-year period beginning in 2026.
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