119-hr3911

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3911 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3911

 To provide for the establishment of Medicare part E public health 
 plans, and for other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 June 11, 2025

 Mr. Gomez (for himself, Mr. Beyer, Mr. Huffman, Mrs. McIver, and Ms. 
 Norton) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
 Ways and Means, and Education and Workforce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
 of such provisions as fall within the jurisdiction of the committee 
 concerned

_______________________________________________________________________

 A BILL

 To provide for the establishment of Medicare part E public health 
 plans, and for other purposes.

 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 ``Choose Medicare Act''.

SEC. 2. PUBLIC HEALTH PLAN.

    (a) In General.--The Social Security Act is amended by adding at 
the end the following:

 ``title xxii--medicare part e public health plans

 ``

Sec. 2201. Public Health Plans.--
 ``

    (a) Establishment.--The Secretary shall establish public health 
plans (to be known as `Medicare part E plans') that are available in 
the individual market, small group market, and large group market.
 ``

    (b) Benefits.--
 ``

    (1) In general.--Each Medicare part E plan, regardless of 
 whether the plan is offered in the individual market, small 
 group market, or large group market, shall be a qualified 
 health plan within the meaning of 

section 1301

    (a) of the 
 Patient Protection and Affordable Care Act (42 U.S.C. 18021

    (a) ) 
 that--
 ``
        (A) meets all requirements applicable to 
 qualified health plans under subtitle D of title I of 
 the Patient Protection and Affordable Care Act (42 
 U.S.C. 18021 et seq.) (other than the requirement under 
 

section 1301

    (a)

    (1)
            (C) 
            (ii) of such Act) and title XXVII 
 of the Public Health Service Act (42 U.S.C. 300gg et 
 seq.);
 ``
        (B) provides coverage of--
 ``
            (i) the essential health benefits 
 described in 

section 1302

    (b) of the Patient 
 Protection and Affordable Care Act (42 U.S.C. 
 18022

    (b) ); and
 ``
            (ii) all items and services for which 
 benefits are available under title XVIII;
 ``
            (C) provides gold-level coverage described in 
 

section 1302
            (d) (1)
            (C) of the Patient Protection and 
 Affordable Care Act (42 U.S.C. 18022
            (d) (1)
            (C) ); and
 ``
            (D) provides coverage of abortions and all other 
 reproductive services.
 ``

    (2) Preemption.--Notwithstanding 

section 1303

    (a)

    (1) of 
 the Patient Protection and Affordable Care Act (42 U.S.C. 
 18023

    (a)

    (1) )--
 ``
        (A) a State may not prohibit a Medicare part E 
 plan from offering the coverage described in paragraph

    (1)
            (D) ; and
 ``
        (B) no provision of State law that would prohibit 
 such a plan from offering such coverage shall apply to 
 such plan.
 ``
            (c) Eligibility; Enrollment.--
 ``

    (1) Availability on the exchanges.--The Medicare part E 
 plans offered in the individual and small group markets shall 
 be offered through the Federal and State Exchanges, including 
 the Small Business Health Options Program Exchanges (commonly 
 referred to as the `SHOP Exchanges').
 ``

    (2) Eligibility.--
 ``
        (A) In general.--Any individual who is a resident 
 of the United States, as determined by the Secretary 
 under subparagraph
            (C) , and who is not an individual 
 described in subparagraph
        (B) , is eligible to enroll in 
 a Medicare part E plan.
 ``
        (B) Exclusions.--An individual described in this 
 subparagraph is any individual who is--
 ``
            (i) entitled to, or enrolled for, 
 benefits under title XVIII;
 ``
            (ii) eligible for medical assistance 
 under a State plan under title XIX; or
 ``
            (iii) enrolled for child health 
 assistance or pregnancy-related assistance 
 under a State plan under title XXI.
 ``
            (C) Regulations.--The Secretary shall promulgate 
 a rule for determining residency for purposes of 
 subparagraph
        (A) .
 ``

    (3) Employer-sponsored plans.--
 ``
        (A) Employer enrollment.--Effective with respect 
 to the first plan year that begins 1 year after the 
 date of enactment of the Choose Medicare Act and each 
 plan year thereafter, the Secretary shall provide 
 options for Medicare part E plans in the small group 
 market and large group market that are voluntary, and 
 available to all employers.
 ``
        (B) Group health plans.--The Secretary, acting 
 through the Administrator for the Centers for Medicare 
 & Medicaid Services, at the request of a plan sponsor, 
 shall serve as a third party administrator of a group 
 health plan that is a Medicare part E plan offered by 
 such sponsor.
 ``
            (C) Portability for employer-sponsored plans.--
 The Secretary shall develop a process for allowing 
 individuals enrolled in a Medicare part E plan offered 
 in the small group market or large group market to 
 maintain health insurance coverage through a Medicare 
 part E plan if the individual subsequently loses 
 eligibility for enrollment in such a plan based on 
 termination of the employment relationship. The ability 
 to maintain such coverage shall exist regardless of 
 whether the individual has the option to enroll in 
 other health insurance coverage, including coverage 
 offered in the individual market or through a 
 subsequent employer.
 ``
            (d) Premiums.--The Secretary shall establish premium rates for 
the Medicare part E plans that--
 ``

    (1) are adjusted based on--
 ``
        (A) whether the plan is offered in the individual 
 market, small group market, or large group market; and
 ``
        (B) the applicable rating area;
 ``

    (2) are at a level sufficient to fully finance--
 ``
        (A) the costs of health benefits provided by such 
 plans; and
 ``
        (B) administrative costs related to operating the 
 plans; and
 ``

    (3) comply with the requirements under 

section 2701 of 
 the Public Health Service Act (42 U.S.C. 300gg), including for 
 such plans that are offered in the large group market.
 ``

    (e) Providers and Reimbursement Rates.--
 ``

    (1) In general.--The Secretary shall establish a rate 
 schedule for reimbursing types of health care providers 
 furnishing items and services under the Medicare part E plans 
 at rates that are consistent with the negotiations described in 
 paragraph

    (2) and are necessary to maintain network adequacy.
 ``

    (2) Manner of negotiation.--The Secretary shall negotiate 
 the rates described in paragraph

    (1) in a manner that results 
 in payment rates that are not lower, in the aggregate, than 
 rates under title XVIII, and not higher, in the aggregate, than 
 the average rates paid by other health insurance issuers 
 offering health insurance coverage through an Exchange.
 ``

    (3) Participating providers.--
 ``
        (A) In general.--A health care provider that is a 
 participating provider of services or supplier under 
 the Medicare program under title XVIII on the date of 
 enactment of the Choose Medicare Act shall be a 
 participating provider for Medicare part E plans.
 ``
        (B) Additional providers.--The Secretary shall 
 establish a process to allow health care providers not 
 described in subparagraph
        (A) to become participating 
 providers for Medicare part E plans.
 ``

    (4) Limitations on balance billing.--The limitations on 
 balance billing pursuant to the provisions of 

section 1866

    (a)

    (1)
        (A) shall apply to participating providers for 
 Medicare part E plans in the same manner as such provisions 
 apply to participating providers under the Medicare program.
 ``

    (f) Encouraging Use of Alternative Payment Models.--The Secretary 
shall, as applicable, utilize alternative payment models, including 
those described in 

section 1833

    (z)

    (3)
            (C) , in making payments for items 
and services (including prescription drugs) furnished under Medicare 
part E plans. The payment rates under such alternative payment models 
shall comply with the requirement for negotiated rates under subsection

    (e)

    (2) .
 ``

    (g) Prescription Drugs.--The Secretary shall apply the provisions 
of part E of title XI to prescription drugs under Medicare part E plans 
in the same manner as such provisions apply with respect to selected 
drugs under part E of title XI.
 ``

    (h) Appropriations.--
 ``

    (1) Start up funding.--For purposes of establishing the 
 Medicare part E plans, there is appropriated to the Secretary, 
 out of any funds in the Treasury not otherwise obligated, 
 $2,000,000,000, for fiscal year 2026.
 ``

    (2) Initial reserves.--There is appropriated to the 
 Secretary, out of any funds in the Treasury not otherwise 
 obligated, such sums as may be necessary, based on projected 
 enrollment in the Medicare part E plans in the first plan year 
 in which such plans are offered, to provide reserves for the 
 purpose of paying claims filed during the initial 90-day period 
 of such plan year.
 ``

    (3) Clarification.--Any provision of law restricting the 
 use of Federal funds with respect to any reproductive health 
 service shall not apply to funds appropriated under paragraph

    (1) or

    (2) .
 ``
            (i) Health Insurance Issuer.--With respect to any Medicare part E 
plan, the Secretary shall be considered a health insurance issuer, 
within the meaning of 

section 2791

    (b) of the Public Health Service Act 
(42 U.S.C. 300gg-91

    (b) ).''.

    (b) Application of Excise Tax for Noncompliance With Negotiation 
Requirements.--

Section 5000D

    (e)

    (1) of the Internal Revenue Code of 1986 
is amended by adding at the end the following new sentence: ``Such term 
shall apply to any drug treated in the same manner as a drug described 
in the preceding sentence by reason of 

section 2201

    (g) of the Social 
Security Act.''.

SEC. 3. NOTICE AND NAVIGATOR REFERRAL FOR EMPLOYEES UNDER THE FAIR 
 LABOR STANDARDS ACT OF 1938.

    (a) In General.--

Section 18B of the Fair Labor Standards Act of 
1938 (29 U.S.C. 218b) is amended--

    (1) in the heading, by striking ``to'' and inserting ``and 
 navigator referral for'';

    (2) by redesignating subsection

    (b) as subsection
            (c) ;

    (3) by inserting after subsection

    (a) the following:
 ``

    (b) Navigator Referral.--
 ``

    (1) In general.--An employer described in paragraph

    (3) shall refer each employee who is a full-time employee (as 
 defined in 

section 4980H
            (c) of the Internal Revenue Code of 
 1986) to--
 ``
        (A) an entity that serves as a navigator under 
 

section 1311
            (i) of the Patient Protection and 
 Affordable Care Act (42 U.S.C. 18031
            (i) ) for the 
 Exchange operating in the State of the employer; or
 ``
        (B) if the Exchange operating in the State of the 
 employer does not have an entity serving as such a 
 navigator, another entity that shall carry out 
 equivalent activities as such a navigator.
 ``

    (2) Referral.--The referral described in paragraph

    (1) shall occur--
 ``
        (A) at the time the employer hires the employee; 
 or
 ``
        (B) on the effective date described in subsection
            (c) (2) with respect to an employee who is currently 
 employed by the employer on such date.
 ``

    (3) Employer.--An employer described in this paragraph is 
 any employer that--
 ``
        (A) does not provide an eligible employer-
 sponsored plan as defined in 

section 5000A

    (f)

    (2) of the 
 Internal Revenue Code of 1986; or
 ``
        (B) provides such an eligible employer-sponsored 
 plan, but the plan is determined--
 ``
            (i) to be unaffordable to the employee 
 under clause
            (i) of 

section 36B
            (c) (2)
            (C) of 
 such Code; or
 ``
            (ii) to not provide the required minimum 
 value under clause
            (ii) of such section.''; and

    (4) in subsection
            (c) , as so redesignated--
        (A) in the heading, by striking ``Effective Date'' 
 and inserting ``Effective Dates'';
        (B) by striking ``Subsection

    (a) '' and inserting 
 the following:
 ``

    (1) Notice.--Subsection

    (a) ''; and
            (C) by adding at the end the following:
 ``

    (2) Navigator referral.--Subsection

    (b) shall take effect 
 with respect to employers in a State beginning on the date that 
 is 2 years after the date of enactment of the Choose Medicare 
 Act.''.

    (b) Study.--Not later than January 1, 2030, the Comptroller General 
of the United States shall conduct a study on the impact of the 
requirements under 

section 18B of the Fair Labor Standards Act of 1938 
(29 U.S.C. 218b), including the amendments made by subsection

    (a) , on 
the rate of individuals without minimum essential coverage as defined 
in 

section 5000A

    (f) of the Internal Revenue Code of 1986 in the United 
States and in each State.
            (c) Funding for Navigator Program.--

Section 1311
            (i) (6) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 18031
            (i) (6) ) is 
amended--

    (1) by striking ``Grants'' and inserting the following:
 ``
        (A) In general.--Grants''; and

    (2) by adding at the end the following:
 ``
        (B) Authorization of appropriations.--There is 
 authorized to be appropriated such sums as may be 
 necessary to address capacity limitations of entities 
 serving as navigators through a grant under this 
 subsection.''.

SEC. 4. PROTECTING AGAINST HIGH OUT-OF-POCKET EXPENDITURES FOR MEDICARE 
 FEE-FOR-SERVICE BENEFITS.

 Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by adding at the end the following new section:

 ``protection against high out-of-pocket expenditures

 ``

Sec. 1899C.

    (a) In General.--Notwithstanding any other provision 
of this title, in the case of an individual entitled to, or enrolled 
for, benefits under part A or enrolled in part B, if the amount of the 
out-of-pocket cost-sharing of such individual for a year (beginning 
with 2027) equals or exceeds the annual out-of-pocket limit under 
subsection

    (b) for that year, the individual shall not be responsible 
for additional out-of-pocket cost-sharing incurred during that year.
 ``

    (b) Annual Out-of-Pocket Limit.--
 ``

    (1) In general.--The amount of the annual out-of-pocket 
 limit under this subsection shall be--
 ``
        (A) for 2027, $6,700; or
 ``
        (B) for a subsequent year, the amount specified 
 in this subsection for the preceding year increased or 
 decreased by the percentage change in the medical care 
 component of the Consumer Price Index for All Urban 
 Consumers for the 12-month period ending with June of 
 such preceding year.
 ``

    (2) Rounding.--If any amount determined under paragraph

    (1)
        (B) is not a multiple of $5, such amount shall be rounded to 
 the nearest multiple of $5.
 ``
            (c) Out-of-Pocket Cost-Sharing Defined.--
 ``

    (1) In general.--Subject to paragraphs

    (2) and

    (3) , in 
 this section, the term `out-of-pocket cost-sharing' means, with 
 respect to an individual, the amount of the expenses incurred 
 by the individual that are attributable to--
 ``
        (A) deductibles, coinsurance, and copayments 
 applicable under part A or B; or
 ``
        (B) for items and services that would have 
 otherwise been covered under part A or B but for the 
 exhaustion of those benefits.
 ``

    (2) Certain costs not included.--
 ``
        (A) Non-covered items and services.--Expenses 
 incurred for items and services which are not covered 
 under part A or B shall not be considered incurred 
 expenses for purposes of determining out-of-pocket 
 cost-sharing under paragraph

    (1) .
 ``
        (B) Items and services not furnished on an 
 assignment-related basis.--If an item or service is 
 furnished to an individual under this title and is not 
 furnished on an assignment-related basis, any 
 additional expenses the individual incurs above the 
 amount the individual would have incurred if the item 
 or service was furnished on an assignment-related basis 
 shall not be considered incurred expenses for purposes 
 of determining out-of-pocket cost-sharing under 
 paragraph

    (1) .
 ``

    (3) Source of payment.--For purposes of paragraph

    (1) , 
 the Secretary shall consider expenses to be incurred by the 
 individual without regard to whether the individual or another 
 person, including a State program, an employer, a medicare 
 supplemental policy, or other third-party coverage, has paid 
 for such expenses.
 ``
            (d) Announcement of the Annual Out-of-Pocket Limit.--The 
Secretary shall (beginning in 2026) announce (in a manner intended to 
provide notice to all interested parties) the annual out-of-pocket 
limit under this section that will be applicable for the succeeding 
year.''.

SEC. 5. ENHANCEMENT OF PREMIUM ASSISTANCE CREDIT.

    (a) Use of Gold Level Plan for Benchmark.--

    (1) In general.--Clause
            (i) of 

section 36B

    (b)

    (2)
        (B) of the 
 Internal Revenue Code of 1986 is amended by striking 
 ``applicable second lowest cost silver plan'' and inserting 
 ``applicable second lowest cost gold plan''.

    (2) Conforming amendment related to affordability.--

Section 36B
            (c) (4)
            (C) 
            (i) 
            (I) of such Code is amended by striking ``second 
 lowest cost silver plan'' and inserting ``second lowest cost 
 gold plan''.

    (3) Other conforming amendments.--Subparagraphs
        (B) and
            (C) of 

section 36B

    (b)

    (3) of such Code are each amended by striking 
 ``silver plan'' each place it appears in the text and the 
 heading and inserting ``gold plan''.

    (b) Permanent Extension of Eligibility Rules.--

    (1) In general.--

Section 36B
            (c) (1) of the Internal Revenue 
 Code of 1986 is amended--
        (A) in subparagraph
        (A) , by striking ``but does not 
 exceed 400 percent'', and
        (B) by striking subparagraph
        (E) .

    (2) Determination of applicable percentage.--Subparagraph
        (A) of 

section 36B

    (b)

    (3) of such Code is amended by striking 
 all that precedes the table in clause
            (iii) 
            (II) and inserting 
 the following:
 ``
        (A) Applicable percentage.--For purposes of 
 paragraph

    (2) , except as provided in clause
            (ii) , 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:''.
            (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2025.

SEC. 6. ENHANCEMENTS FOR REDUCED COST SHARING.

    (a) Definition of Eligible Individual.--

Section 1402

    (b)

    (1) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 18071

    (b)

    (1) ) is 
amended by striking ``silver level'' and inserting ``gold level''.

    (b) Modification of Amount.--

    (1) In general.--

Section 1402
            (c) (2) of the Patient 
 Protection and Affordable Care Act is amended to read as 
 follows:
 ``

    (2) Additional reduction.--The Secretary shall establish 
 procedures under which the issuer of a qualified health plan to 
 which this section applies shall further reduce cost-sharing 
 under the plan in a manner sufficient to--
 ``
        (A) in the case of an eligible insured whose 
 household income is not less than 100 percent but not 
 more than 133 percent of the poverty line for a family 
 of the size involved, increase the plan's share of the 
 total allowed costs of benefits provided under the plan 
 to 94 percent of such costs;
 ``
        (B) in the case of an eligible insured whose 
 household income is more than 133 percent but not more 
 than 150 percent of the poverty line for a family of 
 the size involved, increase the plan's share of the 
 total allowed costs of benefits provided under the plan 
 to 92 percent of such costs;
 ``
            (C) in the case of an eligible insured whose 
 household income is more than 150 percent but not more 
 than 200 percent of the poverty line for a family of 
 the size involved, increase the plan's share of the 
 total allowed costs of benefits provided under the plan 
 to 90 percent of such costs;
 ``
            (D) in the case of an eligible insured whose 
 household income is more than 200 percent but not more 
 than 300 percent of the poverty line for a family of 
 the size involved, increase the plan's share of the 
 total allowed costs of benefits provided under the plan 
 to 85 percent of such costs; and
 ``
        (E) in the case of an eligible insured whose 
 household income is more than 300 percent but not more 
 than 400 percent of the poverty line for a family of 
 the size involved, increase the plan's share of the 
 total allowed costs of benefits provided under the plan 
 to 80 percent of such costs.''.

    (2) Conforming amendment.--Clause
            (i) of 

section 1402
            (c) (1)
        (B) of such Act is amended to read as follows:
 ``
            (i) In general.--The Secretary shall 
 ensure the reduction under this paragraph shall 
 not result in an increase in the plan's share 
 of the total allowed costs of benefits provided 
 under the plan above--
 ``
            (I) 94 percent in the case of an 
 eligible insured described in paragraph

    (2)
        (A) ;
 ``
            (II) 92 percent in the case of an 
 eligible insured described in paragraph

    (2)
        (B) ;
 ``
            (III) 90 percent in the case of 
 an eligible insured described in 
 paragraph

    (2)
            (C) ;
 ``
            (IV) 85 percent in the case of an 
 eligible insured described in paragraph

    (2)
            (D) ; and
 ``
            (V) 80 percent in the case of an 
 eligible insured described in paragraph

    (2)
        (E) .''.
            (c) Effective Date.--The amendments made by this section shall 
apply to plan years beginning after December 31, 2025.

SEC. 7. REINSURANCE AND AFFORDABILITY FUND.

 Part 5 of subtitle D of title I of the Patient Protection and 
Affordable Care Act is amended by inserting after 

section 1341 (42 
U.S.C. 18061) the following:

``

SEC. 1341A. REINSURANCE AND AFFORDABILITY FUND FOR THE INDIVIDUAL 
 MARKET IN EACH STATE.

 ``

    (a) In General.--The Secretary, in consultation with the National 
Association of Insurance Commissioners, shall establish a program to 
enable each State, for any plan year beginning in the 3-year period 
beginning January 1, 2026, to--
 ``

    (1) provide reinsurance payments to health insurance 
 issuers with respect to individuals enrolled under individual 
 health insurance coverage offered by such issuers; or
 ``

    (2) provide assistance (other than through payments 
 described in paragraph

    (1) ) to reduce out-of-pocket costs, such 
 as copayments, coinsurance, premiums, and deductibles, of 
 individuals enrolled under qualified health plans offered in 
 the individual market through an Exchange.
 ``

    (b) Appropriations.--There is appropriated, out of any money in 
the Treasury not otherwise appropriated, $30,000,000,000 for the period 
of fiscal years 2026 to 2028 for purposes of establishing and 
administering the program established under this section. Such amount 
shall remain available until expended.''.

SEC. 8. EXPANDING RATING RULES TO LARGE GROUP MARKET.

    (a) In General.--

Section 2701

    (a) of the Public Health Service Act 
(42 U.S.C. 300gg

    (a) ) is amended--

    (1) in paragraph

    (1) , by striking ``small''; and

    (2) by striking paragraph

    (5) .

    (b) Effective Date.--The amendments made by subsection

    (a) shall 
apply to plans offered in the first plan year beginning after the date 
of enactment of this Act and any plan year thereafter.

SEC. 9. PROTECTION OF CONSUMERS FROM EXCESSIVE, UNJUSTIFIED, OR 
 UNFAIRLY DISCRIMINATORY RATES.

    (a) Protection From Excessive, Unjustified, or Unfairly 
Discriminatory Rates.--

Section 2794 of the Public Health Service Act 
(42 U.S.C. 300gg-94) is amended by adding at the end the following new 
subsection:
 ``

    (e) Protection From Excessive, Unjustified, or Unfairly 
Discriminatory Rates.--
 ``

    (1) Authority of states.--Nothing in this section shall 
 be construed to prohibit a State from imposing requirements 
 (including requirements relating to rate review standards and 
 procedures and information reporting) on health insurance 
 issuers with respect to rates that are in addition to the 
 requirements of this section and are more protective of 
 consumers than such requirements.
 ``

    (2) Consultation in rate review process.--In carrying out 
 this section, the Secretary shall consult with the National 
 Association of Insurance Commissioners and consumer groups.
 ``

    (3) Determination of who conducts reviews for each 
 state.--The Secretary shall determine, after the date of 
 enactment of this subsection and periodically thereafter, the 
 following:
 ``
        (A) In which markets in each State the State 
 insurance commissioner or relevant State regulator 
 shall undertake the corrective actions under paragraph

    (4) , based on the Secretary's determination that the 
 State insurance commissioner or relevant State 
 regulator is adequately undertaking and utilizing such 
 actions in that market.
 ``
        (B) In which markets in each State the Secretary 
 shall undertake the corrective actions under paragraph

    (4) , in cooperation with the relevant State insurance 
 commissioner or State regulator, based on the 
 Secretary's determination that the State is not 
 adequately undertaking and utilizing such actions in 
 that market.
 ``

    (4) Corrective action for excessive, unjustified, or 
 unfairly discriminatory rates.--In accordance with the process 
 established under this section, the Secretary or the relevant 
 State insurance commissioner or State regulator shall take 
 corrective actions to ensure that any excessive, unjustified, 
 or unfairly discriminatory rates are corrected prior to 
 implementation, or as soon as possible thereafter, through 
 mechanisms such as--
 ``
        (A) denying rates;
 ``
        (B) modifying rates; or
 ``
            (C) requiring rebates to consumers.
 ``

    (5) Noncompliance.--
 ``
        (A) In general.--Failure to comply with any 
 corrective action taken by the Secretary under this 
 subsection may result in the application of civil 
 monetary penalties described in subparagraph
        (B) and, 
 if the Secretary determines appropriate, make the plan 
 involved ineligible for classification as a qualified 
 health plan.
 ``
        (B) Civil monetary penalties.--
 ``
            (i) In general.--The provisions of 
 

section 1128A of the Social Security Act, other 
 than subsection

    (a) and

    (b) and the first 
 sentence of subsection
            (c) (1) of such section, 
 shall apply to civil monetary penalties under 
 this paragraph in the same manner as such 
 provisions apply to a penalty or proceeding 
 under 

section 1128A of the Social Security Act.
 ``
            (ii) Amount.--The provisions of 
 subparagraph
            (C) of 

section 2723

    (b)

    (2) shall 
 apply to civil monetary penalties under this 
 paragraph in the same manner as such provisions 
 apply to a penalty under such section.''.

    (b) Clarification of Regulatory Authority.--

Section 2794 of the 
Public Health Service Act (42 U.S.C. 300gg-94) is further amended--

    (1) in subsection

    (a) --
        (A) in the subsection heading, by striking 
 ``Premium'' and inserting ``Rate'';
        (B) in paragraph

    (1) , by striking ``unreasonable 
 increases in premiums'' and inserting ``potentially 
 excessive, unjustified, or unfairly discriminatory 
 rates, including premiums,''; and
            (C) in paragraph

    (2) --
            (i) by striking ``an unreasonable premium 
 increase'' and inserting ``a potentially 
 excessive, unjustified, or unfairly 
 discriminatory rate'';
            (ii) by striking ``the increase'' and 
 inserting ``the rate''; and
            (iii) by striking ``such increases'' and 
 inserting ``such rates''; and

    (2) in subsection

    (b) --
        (A) in the subsection heading, by striking 
 ``Premium'' and inserting ``Rate'';
        (B) by striking ``premium increases'' each place it 
 appears and inserting ``rates'';
            (C) in paragraph

    (1) --
            (i) in the paragraph heading, by striking 
 ``Premium increase'' and inserting ``Rate''; 
 and
            (ii) in subparagraph
        (B) , by striking 
 ``excessive or unjustified'' and inserting 
 ``excessive, unjustified, or unfairly 
 discriminatory''; and
            (D) in paragraph

    (2) --
            (i) in the paragraph heading, by striking 
 ``Premium increases'' and inserting ``Rates''; 
 and
            (ii) in subparagraph
        (B) , by striking 
 ``premium'' and inserting ``rate''.
            (c) Conforming Amendment.--

Section 1311

    (e)

    (2) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18031

    (e)

    (2) ) is amended 
by striking ``excessive or unjustified premium increases'' and 
inserting ``excessive, unjustified, or unfairly discriminatory rates''.
            (d) Applicability to Grandfathered Health Plans.--

Section 1251

    (a)

    (5) of the Patient Protection and Affordable Care Act (42 U.S.C. 
18011

    (a)

    (5) ) is amended--

    (1) by striking ``Sections 2799A-1'' and inserting the 
 following:
 ``
        (A) In general.--Sections 2799A-1''; and

    (2) by adding at the end the following:
 ``
        (B) Ensuring that consumers get value for their 
 dollars.--

Section 2794 of the Public Health Service Act 
 shall apply to grandfathered health plans for plan 
 years beginning on or after January 1, 2026.''.

    (e) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act and shall be implemented 
with respect to health plans beginning not later than January 1, 2026.

SEC. 10. SENSE OF CONGRESS.

 It is the sense of the Congress that--

    (1) the Federal Government, acting in its capacity as an 
 insurer, employer, or health care provider, should serve as a 
 model for the Nation to ensure coverage of all reproductive 
 services; and

    (2) all restrictions on coverage of reproductive services 
 in the private insurance market should end.
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