To provide for the establishment of Medicare part E public health plans, and for other purposes.
Summary
What This Bill Does
The bill amends the Social Security Act by adding Title XXII to establish Medicare Part E public health plans available in the individual, small group, and large group markets, provides the new Title XXII of the Social Security Act establishing Medicare Part E plan structure: gold-level qualified health plans covering essential health benefits, all Medicare services, and reproductive services, and amends the Fair Labor Standards Act to require employers that do not offer affordable, minimum-value employer-sponsored health plans to refer each full-time employee to an Exchange navigator (or equivalent entity). It relies on appropriations, price controls, compliance mandates, and exemptions. The main policy areas are Healthcare and Finance.
Who Benefits and How
Uninsured and underinsured individuals could see lower costs, Individual market enrollees could see lower costs, and Medicare fee-for-service beneficiaries could see lower costs.
Who Bears the Burden and How
Federal taxpayers could face higher costs, Health insurance issuers would take on compliance duties, and Private health insurers could lose revenue opportunities.
Key Provisions
- Amends the Social Security Act by adding Title XXII to establish Medicare Part E public health plans available in the individual, small group, and large group markets.
- Provides the new Title XXII of the Social Security Act establishing Medicare Part E plan structure: gold-level qualified health plans covering essential health benefits, all Medicare services, and reproductive services.
- Amends the Fair Labor Standards Act to require employers that do not offer affordable, minimum-value employer-sponsored health plans to refer each full-time employee to an Exchange navigator (or equivalent entity).
- Adds Section 1899C to the Social Security Act establishing an annual out-of-pocket maximum for Medicare fee-for-service beneficiaries.
- Amends Section 36B of the Internal Revenue Code to enhance ACA premium tax credits in three ways: (1) changes the benchmark plan from the second lowest cost silver plan to the second lowest cost gold plan, increasing...
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
The bill amends the Social Security Act by adding Title XXII to establish Medicare Part E public health plans available in the individual, small group, and large group markets, provides the new Title XXII of the Social Security Act establishing Medicare Part E plan structure: gold-level qualified health plans covering essential health benefits, all Medicare services, and reproductive services, and amends the Fair Labor Standards Act to require employers that do not offer affordable, minimum-value employer-sponsored health plans to refer each full-time employee to an Exchange navigator (or equivalent entity).
Key Policy Areas
Healthcare, Finance
Primary Purpose
The bill amends the Social Security Act by adding Title XXII to establish Medicare Part E public health plans available in the individual, small group, and large group markets, provides the new Title XXII of the Social Security Act establishing Medicare Part E plan structure: gold-level qualified health plans covering essential health benefits, all Medicare services, and reproductive services, and amends the Fair Labor Standards Act to require employers that do not offer affordable, minimum-value employer-sponsored health plans to refer each full-time employee to an Exchange navigator (or equivalent entity).
Policy Domains
Medicare Part E Public Health Plans (Sec. 2)
Identified Gains
- Uninsured and underinsured individuals
- Individual market enrollees
- Medicare fee-for-service beneficiaries
- Low-income enrollees (100-200% FPL)
- ACA marketplace enrollees
Identified Costs
- Federal taxpayers
- Health insurance issuers
- Private health insurers
- Pharmaceutical companies
- Medicare trust funds / federal government
Sponsors
Legislative Progress
IntroducedMr. Merkley (for himself, Mr. Murphy, Ms. Baldwin, Mr. Blumenthal, …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
ACA marketplace enrollees, Employees without adequate employer coverage, Health insurance consumers
Positive-direction: ACA marketplace enrollees, Employees without adequate employer coverage, Health insurance consumers, Individual market enrollees, Low-income enrollees (100-200% FPL), Medicare fee-for-service beneficiaries, Middle- and upper-income households above 400% FPL, Moderate-income enrollees (200-400% FPL), Uninsured and underinsured individuals
Negative-direction: Taxpayers
Grandfathered health plan sponsors, Health insurance issuers, Health insurance issuers in individual market
Health insurance issuers faces effects in multiple directions
Positive-direction: Health insurance issuers in individual market
Negative-direction: Grandfathered health plan sponsors, Medigap insurers, Private health insurers
Centers for Medicare & Medicaid Services, Medicare trust funds / federal government, State governments
Positive-direction: State governments, States
Negative-direction: Centers for Medicare & Medicaid Services, Medicare trust funds / federal government
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
- "the_administrator"
- → Administrator for the Centers for Medicare & Medicaid Services
- "the_comptroller_general"
- → Comptroller General of the United States
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
Note: {'term': 'The Secretary', 'resolution': 'Refers to the Secretary of Health and Human Services throughout the bill.'}
Key Definitions
Terms defined in this bill
Public health plans established by the Secretary, available in the individual, small group, and large group markets, providing gold-level coverage of essential health benefits plus all Medicare-covered services and reproductive services.
Expenses incurred by an individual attributable to deductibles, coinsurance, and copayments under Medicare Part A or B, or for services that would have been covered but for benefit exhaustion. Excludes non-covered items and amounts above assignment-related rates.
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology