U.S. Department of Health & Human Services (HHS) / Centers for Medicare & Medicaid Services (CMS)

• 42 C.F.R. Part 406, Subpart A — Medicare entitlement and initial enrollment rules limiting Part A/B to age-65+/disability groups. • 42 C.F.R. § 422.4 — Definition of Medicare Advantage plans exclusively as private‐insurer offerings, barring government-run or public-option carriers. • 45 C.F.R. § 155.20 — Definition of “Qualified Health Plan issuer” requiring state-licensed private health insurers to offer Exchange coverage.

—OPTIONAL--

Notice of Proposed Rulemaking

Structural Barriers to Universal Public-Option and Nationalized Healthcare (“No Public Option” Provisions)

Federal regulations today confine Medicare enrollment to seniors and certain disabled persons (42 C.F.R. Part 406, Subpart A), prohibit any government-run or public-option plan from participating in Medicare Advantage (42 C.F.R. § 422.4), and restrict ACA Marketplace coverage to state-licensed private insurers (45 C.F.R. § 155.20). Striking these rules would clear the way for a federally sponsored public-option or universal buy-in—empowering any American to enroll in a government-run health plan alongside private options, enhancing competition, and driving down premiums and cost-sharing.

U.S. Department of Health & Human Services 200 Independence Avenue, SW Washington, DC 20201

(301) 492-4305 (410) 786-1524 (410) 786-8437

Medicare’s authorizing statute limits entitlement to those 65+ or with qualifying disabilities; CMS codified that at 42 C.F.R. Part 406, Subpart A. When CMS created Medicare Advantage, it defined participating plans under § 422.4 as exclusively private carriers. Under the ACA, HHS defined Qualified Health Plan issuers in 45 C.F.R. § 155.20 to be state-licensed private insurers, effectively excluding any public-sector carrier from Marketplace offerings.

Deleting Part 406, Subpart A would allow CMS to extend Part A/B eligibility beyond age and disability criteria. Striking § 422.4 would permit a government-run or public-option carrier to compete in Medicare Advantage. Removing § 155.20 would enable a public-sector plan to be certified as a QHP on the ACA Exchanges. Together, these changes create a true universal public-option framework that can expand access, foster competition, and lower costs.

— 42 C.F.R. Part 406, Subpart A removed; no regulatory restriction on who may enroll in Medicare Part A/B beyond statutory criteria, enabling future rulemaking to open eligibility broadly. — 42 C.F.R. § 422.4 deleted; “Medicare health plans” definition expands to include government-run and hybrid public-option entities. — 45 C.F.R. § 155.20 struck; no requirement that QHP issuers be state-licensed private insurers, permitting public-option carriers to sell on the ACA Exchanges. All other provisions in Parts 406, 422, and 155 remain in effect.

Robert F. Kennedy Jr.

Secretary of Health and Human Services