CHOICE Act

II 117TH CONGRESS 1ST SESSION S. 983 To amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes. IN THE SENATE OF THE UNITED STATES MARCH 25, 2021 Mr. WHITEHOUSE (for himself and Mr. BROWN) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions A BILL To amend the Patient Protection and Affordable Care Act to establish a public health insurance option, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Consumer Health Op- 4 tions and Insurance Competition Enhancement Act’’ or 5 the ‘‘CHOICE Act’’. 6 SEC. 2. PUBLIC HEALTH INSURANCE OPTION. 7 (a) IN GENERAL.—Part 2 of subtitle D of title I of 8 the Patient Protection and Affordable Care Act (42 9 VerDate Sep 11 2014 22:10 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S983.IS S983 kjohnson on DSK79L0C42PROD with BILLS 2 •S 983 IS U.S.C. 18031 et seq.) is amended by adding at the end 1 the following: 2 ‘‘SEC. 1314. PUBLIC HEALTH INSURANCE OPTION. 3 ‘‘(a) ESTABLISHMENT.— 4 ‘‘(1) IN GENERAL.—For plans years beginning 5 on or after January 1, 2023, the Secretary shall es- 6 tablish, and provide for the offering through the Ex- 7 changes of, a qualified health plan (in this section 8 referred to as the ‘public health insurance option’) 9 that provides value, choice, competition, and stability 10 of affordable, high-quality coverage throughout the 11 United States in accordance with this section. 12 ‘‘(2) PRIMARY RESPONSIBILITY.—In designing 13 the public health insurance option, the primary re- 14 sponsibility of the Secretary shall be to create an af- 15 fordable health plan without compromising quality 16 or access to care. 17 ‘‘(b) ADMINISTRATING THE PUBLIC HEALTH INSUR- 18 ANCE OPTION.— 19 ‘‘(1) OFFERED THROUGH EXCHANGES.— 20 ‘‘(A) EXCLUSIVE TO EXCHANGES.—The 21 public health insurance option shall be offered 22 exclusively by the Secretary through the Ex- 23 changes and not by a health insurance issuer. 24 VerDate Sep 11 2014 22:10 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S983.IS S983 kjohnson on DSK79L0C42PROD with BILLS 3 •S 983 IS ‘‘(B) ENSURING A LEVEL PLAYING 1 FIELD.—Except as otherwise provided under 2 this section, the public health insurance option 3 shall comply with requirements under this title, 4 and title XXVII of the Public Health Service 5 Act, that are applicable to health plans offered 6 through the Exchanges, including requirements 7 related to benefits, benefit levels, provider net- 8 works, notices, consumer protections, and cost- 9 sharing. 10 ‘‘(C) PROVISION OF BENEFIT LEVELS.— 11 The public health insurance option shall offer 12 bronze, silver, and gold plans. 13 ‘‘(2) ADMINISTRATIVE CONTRACTING.— 14 ‘‘(A) AUTHORITIES.—The Secretary may 15 enter into contracts for the purpose of per- 16 forming administrative functions (including 17 functions described in subsection (a)(4) of sec- 18 tion 1874A of the Social Security Act) with re- 19 spect to the public health insurance option in 20 the same manner as the Secretary may enter 21 into contracts under subsection (a)(1) of such 22 section. The Secretary shall have the same au- 23 thority with respect to the public health insur- 24 ance option as the Secretary has under such 25 VerDate Sep 11 2014 22:10 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S983.IS S983 kjohnson on DSK79L0C42PROD with BILLS 4 •S 983 IS subsection (a)(1) and subsection (b) of section 1 1874A of the Social Security Act with respect 2 to title XVIII of such Act. 3 ‘‘(B) TRANSFER OF INSURANCE RISK.— 4 Any contract under this paragraph shall not in- 5 volve the transfer of insurance risk from the 6 Secretary to the entity entering into such con- 7 tract with the Secretary. 8 ‘‘(3) STATE ADVISORY COUNCIL.— 9 ‘‘(A) ESTABLISHMENT.—A State may es- 10 tablish a public or nonprofit entity to serve as 11 the State Advisory Council to provide rec- 12 ommendations to the Secretary on the oper- 13 ations and policies of the public health insur- 14 ance option offered through the Exchange oper- 15 ating in the State. 16 ‘‘(B) RECOMMENDATIONS.—A State Advi- 17 sory Council established under subparagraph 18 (A) shall provide recommendations on at least 19 the following: 20 ‘‘(i) Policies and procedures to inte- 21 grate quality improvement and cost con- 22 tainment mechanisms into the health care 23 delivery system. 24 VerDate Sep 11 2014 22:10 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S983.IS S983 kjohnson on DSK79L0C42PROD with BILLS 5 •S 983 IS ‘‘(ii) Mechanisms to facilitate public 1 awareness of the availability of the public 2 health insurance option. 3 ‘‘(iii) Alternative payment models and 4 value-based insurance design under the 5 public health insurance option that encour- 6 age quality improvement and cost control. 7 ‘‘(C) MEMBERS.—The members of any 8 State Advisory Council shall be representatives 9 of the public and include health care consumers 10 and health care providers. 11 ‘‘(D) APPLICABILITY OF RECOMMENDA- 12 TIONS.—The Secretary may apply the rec- 13 ommendations of a State Advisory Council to 14 the public health insurance option in that State, 15 in any other State, or in all States. 16 ‘‘(4) DATA COLLECTION.—The Secretary shall 17 collect such data as may be required— 18 ‘‘(A) to establish rates for premiums and 19 health care provider reimbursement under sub- 20 section (c); and 21 ‘‘(B) for other purposes under this section, 22 including to improve quality, and reduce racial, 23 ethnic, and other disparities, in health and 24 health care. 25 VerDate Sep 11 2014 22:10 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S983.IS S983 kjohnson on DSK79L0C42PROD with BILLS 6 •S 983 IS ‘‘(c) FINANCING THE PUBLIC HEALTH INSURANCE 1 OPTION.— 2 ‘‘(1) PREMIUMS.— 3 ‘‘(A) ESTABLISHMENT.—The Secretary 4 shall establish geographically adjusted premium 5 rates for the public health insurance option— 6 ‘‘(i) in a manner that complies with 7 the requirement for premium rates under 8 subparagraph (C) and considers the data 9 collected under subsection (b)(4); and 10 ‘‘(ii) at a level sufficient to fully fi- 11 nance— 12 ‘‘(I) the costs of health benefits 13 provided by the public health insur- 14 ance option; and 15 ‘‘(II) administrative costs related 16 to operating the public health insur- 17 ance option. 18 ‘‘(B) CONTINGENCY MARGIN.—In estab- 19 lishing premium rates under subparagraph (A), 20 the Secretary shall include an appropriate 21 amount for a contingency margin. 22 ‘‘(C) VARIATIONS IN PREMIUM RATES.— 23 The premium rate charged for the public health 24 insurance option may not vary except as pro- 25 VerDate Sep 11 2014 22:10 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S983.IS S983 kjohnson on DSK79L0C42PROD with BILLS 7 •S 983 IS vided under section 2701 of the Public Health 1 Service Act. 2 ‘‘(2) HEALTH CARE PROVIDER PAYMENT RATES 3 FOR ITEMS AND SERVICES.— 4 ‘‘(A) IN GENERAL.— 5 ‘‘(i) RATES NEGOTIATED BY THE SEC- 6 RETARY.—Not later than January 1, 2022, 7 and except as provided in clause (ii), the 8 Secretary shall, through a negotiated 9 agreement with health care providers, es- 10 tablish rates for reimbursing health care 11 providers for providing the benefits covered 12 by the public health insurance option. 13 ‘‘(ii) MEDICARE REIMBURSEMENT 14 RATES.—If the Secretary and health care 15 providers are unable to reach a negotiated 16 agreement on a reimbursement rate, the 17 Secretary shall reimburse providers at 18 rates determined for equivalent items and 19 services under the original medicare fee- 20 for-service program under parts A and B 21 of title XVIII of the Social Security Act. 22 ‘‘(iii) FOR NEW SERVICES.—The Sec- 23 retary shall modify reimbursement rates 24 described in clause (ii) in order to accom- 25 VerDate Sep 11 2014 22:10 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S983.IS S983 kjohnson on DSK79L0C42PROD with BILLS 8 •S 983 IS modate payments for services, such as 1 well-child visits, that are not otherwise cov- 2 ered under the original medicare fee-for- 3 service program. 4 ‘‘(B) PRESCRIPTION DRUGS.—Any pay- 5 ment rate under this subsection for a prescrip- 6 tion drug shall be at a rate negotiated by the 7 Secretary. If the Secretary is unable to reach a 8 negotiated agreement on such a reimbursement 9 rate, the Secretary shall use rates determined 10 for equivalent drugs paid for under the original 11 medicare fee-for-service program. The Secretary 12 shall modify such rates in order to accommo- 13 date payments for drugs that are not otherwise 14 covered under the original medicare fee-for- 15 service program. 16 ‘‘(3) ACCOUNT.— 17 ‘‘(A) ESTABLISHMENT.—There is estab- 18 lished in the Treasury of the United States an 19 account for the receipts and disbursements at- 20 tributable to the operation of the public health 21 insurance option, including the start-up funding 22 under subparagraph (C) and appropriations au- 23 thorized under subparagraph (D). 24 VerDate Sep 11 2014 22:10 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S983.IS S983 kjohnson on DSK79L0C42PROD with BILLS 9 •S 983 IS ‘‘(B) PROHIBITION OF STATE IMPOSITION 1 OF TAXES.—Section 1854(g) of the Social Se- 2 curity Act shall apply to receipts and disburse- 3 ments described in subparagraph (A) in the 4 same manner as such section applies to pay- 5 ments or premiums described in such section. 6 ‘‘(C) START-UP FUNDING.— 7 ‘‘(i) AUTHORIZATION OF FUNDING.— 8 There are authorized to be appropriated 9 such sums as may be necessary to estab- 10 lish the public health insurance option and 11 cover 90 days of claims reserves based on 12 projected enrollment. 13 ‘‘(ii) AMORTIZATION OF START-UP 14 FUNDING.—The Secretary shall provide for 15 the repayment of the startup funding pro- 16 vided under clause (i) to the Treasury in 17 an amortized manner over the 10-year pe- 18 riod beginning on January 1, 2023. 19 ‘‘(D) ADDITIONAL AUTHORIZATION OF AP- 20 PROPRIATIONS.—To carry out paragraph (2) of 21 subsection (b), there are authorized to be ap- 22 propriated such sums as may be necessary. 23 ‘‘(d) HEALTH CARE PROVIDER PARTICIPATION.— 24 ‘‘(1) PROVIDER PARTICIPATION.— 25 VerDate Sep 11 2014 22:10 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S983.IS S983 kjohnson on DSK79L0C42PROD with BILLS 10 •S 983 IS ‘‘(A) IN GENERAL.—The Secretary shall 1 establish conditions of participation for health 2 care providers under the public health insurance 3 option. 4 ‘‘(B) LICENSURE OR CERTIFICATION.— 5 The Secretary shall not allow a health care pro- 6 vider to participate in the public health insur- 7 ance option unless such provider is appro- 8 priately licensed or certified under State law. 9 ‘‘(2) ESTABLISHMENT OF A PROVIDER NET- 10 WORK.— 11 ‘‘(A) MEDICARE AND MEDICAID PARTICI- 12 PATING PROVIDERS.—A health care provider 13 that is a participating provider of services or 14 supplier under the Medicare program under 15 title XVIII of the Social Security Act or under 16 a State Medicaid plan under title XIX of such 17 Act is a participating provider in the public 18 health insurance option unless the health care 19 provider opts out of participating in the public 20 health insurance option through a process es- 21 tablished by the Secretary. 22 ‘‘(B) ADDITIONAL PROVIDERS.—The Sec- 23 retary shall establish a process to allow health 24 care providers not described in subparagraph 25 VerDate Sep 11 2014 22:10 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S983.IS S983 kjohnson on DSK79L0C42PROD with BILLS 11 •S 983 IS (A) to become participating providers in the 1 public health insurance option.’’. 2 (b) CONFORMING AMENDMENTS.— 3 (1) TREATMENT AS A QUALIFIED HEALTH 4 PLAN.—Section 1301(a) of the Patient Protection 5 and Affordable Care Act (42 U.S.C. 18021(a)) is 6 amended— 7 (A) in paragraph (1)(C), by inserting ‘‘ex- 8 cept in the case of the public health insurance 9 option established under section 1314,’’ before 10 ‘‘is offered by’’; 11 (B) in paragraph (2)— 12 (i) in the paragraph heading, by in- 13 serting ‘‘, THE PUBLIC HEALTH INSUR- 14 ANCE OPTION,’’ before ‘‘AND’’; and 15 (ii) by inserting ‘‘the public health in- 16 surance option under section 1314,’’ before 17 ‘‘and a multi-State plan’’; and 18 (C) by adding at the end the following: 19 ‘‘(5) PUBLIC HEALTH INSURANCE OPTION.— 20 The term ‘qualified health plan’ shall include the 21 public health insurance option established under sec- 22 tion 1314, notwithstanding the requirement under 23 paragraph (1)(C) for the plan to be offered by a 24 health insurance issuer.’’. 25 VerDate Sep 11 2014 22:10 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S983.IS S983 kjohnson on DSK79L0C42PROD with BILLS 12 •S 983 IS (2) LEVEL PLAYING FIELD.—Section 1324(a) 1 of the Patient Protection and Affordable Care Act 2 (42 U.S.C. 18044(a)) is amended by inserting ‘‘the 3 public health insurance option under section 1314,’’ 4 before ‘‘or a multi-State qualified health plan’’. 5 Æ VerDate Sep 11 2014 22:10 Apr 18, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\S983.IS S983 kjohnson on DSK79L0C42PROD with BILLS