US SB3369

Creates a new "Medicare Exchange health plan" administered by HHS, available in individual and small group markets through ACA exchanges starting plan year 2028, with eligibility for qualified individuals not enrolled in Medicare

Appropriates $1 billion for a Plan Reserve Fund and $1 billion for a Data and Technology Fund in fiscal year 2027 to establish and administer the program

Reimburses providers at Medicare fee-for-service rates, with authority to increase rural area payments by up to 50%, and requires the Secretary to negotiate prescription drug prices

Requires Medicare and Medicaid providers to participate in the new plan starting January 1, 2028, unless they opt out under exceptional circumstances where participation threatens their ability to operate

Expands ACA premium tax credits by removing the 400% of poverty income cap, establishes a reinsurance program with $10 billion authorized annually for fiscal years 2028-2030, and authorizes $50 million to DOJ Antitrust Division and $100 million to FTC annually for health care market enforcement