Title III — S. 4521 (Introduced in Senate)

301. Establishment of health plan

(a)

In general— The Secretary shall establish a coordinated and low-cost health plan (referred to in this section as the “health plan”) to provide access to quality health care for enrollees.

(b)

Individual market availability— The Secretary shall make the health plan available in the individual market for plan year 2022 and each subsequent plan year.

(c)

Rulemaking— The Secretary may promulgate such regulations as may be necessary to carry out this title.

(d)

Authorization of appropriations— There are authorized to be appropriated such sums as may be necessary to carry out this title.

302. Availability of plan

(a)

Eligibility— An individual shall be eligible to enroll in the health plan if such individual, for the entire period for which enrollment is sought—

(1)

is a qualified individual within the meaning of section 1312 of the Patient Protection and Affordable Care Act (42 U.S.C. 18032);

(2)

is not eligible for benefits under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.); and

(3)

is not otherwise eligible for, or has been otherwise offered, employer-sponsored health care coverage.

(b)

Exchanges— The health plan shall be made available through the Exchanges, including the Small Business Health Options Program Exchange.

303. Affordability

The Secretary shall ensure that coverage options for the health plan are not more costly than comparable options offered on the Exchange in the applicable market.

304. Participating providers

(a)

Requirement To participate in order To be enrolled under Medicare— Beginning January 1, 2021, the Secretary may require a health care provider enrolled under the Medicare program under section 1866(j) of the Social Security Act (42 U.S.C. 1395cc(j)) to be a participating provider under the health plan.

(b)

Requirement To participate in order To participate in Medicaid— Beginning January 1, 2021, the Secretary may require a health care provider under a State Medicaid plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) to also be a participating provider under the health plan.

305. Provider payment rates

The Secretary shall set competitive provider payment rates under the health plan using the best information publically available and data otherwise accessible to the Secretary. The Secretary shall give consideration to existing provider payment rates for commercial health plans and provider costs to deliver care, giving special consideration to increased costs for providers to deliver care in rural and medically underserved areas.

306. No effect on Medicare benefits or Medicare trust funds

Nothing in this title shall—

(1)

affect the benefits available under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.); or

(2)

impact the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) or the Federal Supplementary Medical Insurance Trust Fund under section 1841 of the Social Security Act (42 U.S.C. 1395t) (including the Medicare Prescription Drug Account within such Trust Fund).

Title III — Establishment of a Public Health Care Option

III Establishment of a Public Health Care Option