US SB2032

Creates "Medicare Part E" public health plans available in individual, small group, and large group markets through ACA exchanges, offering gold-level coverage including essential health benefits, all Medicare Part XVIII services, and reproductive services including abortion

Establishes provider reimbursement rates negotiated between Medicare and average private insurer rates, with all current Medicare providers automatically participating; applies Medicare drug price negotiation provisions to Part E plans

Appropriates $2 billion for FY2026 startup costs plus additional sums for initial reserves; appropriates $30 billion for 2026-2028 for a state reinsurance and affordability fund to reduce premiums and out-of-pocket costs

Enhances ACA premium tax credits by using gold-level (instead of silver-level) plans as the benchmark, permanently removes the 400% poverty level income cap, and increases cost-sharing reductions to cover 80-94% of costs for households up to 400% of poverty

Establishes a $6,700 annual out-of-pocket maximum for traditional Medicare fee-for-service beneficiaries beginning in 2027, indexed to medical inflation, and extends insurance rating rules to the large group market