This bill creates a new government-run health insurance option called the Medicare Exchange health plan, starting in 2028. It would be available to people who buy insurance on their own (not through an employer) and to small businesses, offering an alternative to private insurance plans. The government would set it up with $2 billion in initial funding to build the infrastructure and technology needed.

The new plan would work similarly to existing health insurance but with some key differences. It would offer free primary care visits with no copays or deductibles, and would pay doctors and hospitals using Medicare's existing payment rates (though it could pay up to 50% more in rural areas). The plan would be required to cover at least silver and gold level benefits, matching what other plans on the insurance marketplace offer. Importantly, any doctor or hospital that accepts Medicare or Medicaid patients would also have to accept this new plan, though they could opt out in rare circumstances.

The bill also makes changes to help people afford insurance. It removes the current income cap for tax credits that help pay premiums, meaning people earning more than 400% of the poverty level could now qualify for help. It adjusts how much people have to pay toward employer insurance before they can get government help—raising the threshold from 9.5% to account for family coverage. Additionally, the government would create a fund to help reduce premiums for people buying individual insurance by pooling the costs of the sickest patients. Finally, the bill gives the Justice Department and Federal Trade Commission $150 million to investigate and challenge anticompetitive practices in health care markets that drive up costs.