States could let anyone buy into Medicaid starting in 2026

What does this do?

This bill would let states create a public option by allowing any resident without other coverage to buy into the state's Medicaid program starting in 2026, sold on the state's ACA Exchange alongside private plans. States could charge income-based premiums and cost-sharing, and buyers could use existing ACA tax credits and subsidies. The bill also permanently raises Medicaid primary care payment rates, extends higher federal funding for ACA expansion states, updates quality measures by 2030, and requires state Medicaid programs to cover comprehensive sexual and reproductive health services, including abortion, to receive federal funds.

Who does it affect?

Primarily affects uninsured people and individual insurance buyers, especially in areas with limited insurer competition. Also affects state governments, health care providers, and private insurers competing on state exchanges.

Why does it matter?

A Medicaid public option could shift enrollment away from private insurance plans on state exchanges, changing competitive dynamics in insurance markets. Requiring abortion coverage as a condition of federal Medicaid funding could create conflicts for states with different policies.

What does it cost, and who pays?

States would receive federal funding to help cover administrative costs of running the public option, and the federal government would permanently continue paying a higher matching rate for ACA Medicaid expansion states.

Where does it stand?