To prohibit funds made available to the Department of Health and Human Services by previous Appropriations Acts from being used for any activity that makes Medicare Advantage the default under the Medicare program.
- Bill Number
- H.R. 6114
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-11-18: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2025-12-02T09:05:27Z
AI-Generated Summary
Purpose
This bill aims to prevent the Department of Health and Human Services (HHS) from using federal funds to automatically enroll eligible individuals into Medicare Advantage (MA) plans as a default option under the Medicare program. Medicare is a government health insurance program primarily for people aged 65 and older or with certain disabilities. Medicare Advantage refers to private health plans approved by Medicare that provide an alternative to traditional Medicare coverage.
Key Provisions
- Funding Restriction: No funds appropriated to HHS in prior fiscal years (for use in the current fiscal year) may be spent on any activity that automatically treats a person's failure to actively choose a health plan as an automatic selection of an MA plan.
- Scope of Prohibition: This applies specifically to individuals who are eligible for Medicare Part A (hospital insurance) and enrolled in Part B (medical insurance) but have not made an explicit election to join an MA plan under Part C (the Medicare Advantage section).
- Exception: The restriction does not apply to existing rules under subsection (c)(3) of section 1851 of the Social Security Act, which outlines specific circumstances for default enrollment (e.g., certain coordinated care scenarios already defined in law).
The bill is a single-section measure and would take effect immediately upon enactment.
Significant Changes to Existing Law
- Limits Implementation Flexibility: Current law (under the Social Security Act) allows HHS to administer Medicare enrollment, including potential defaults in limited cases. This bill introduces a funding-based barrier, preventing HHS from expanding or interpreting rules to make MA the broad default enrollment option without new congressional authorization.
- No Broader Repeal: It does not amend the underlying Medicare statutes but uses appropriations language (a common congressional tool) to block specific administrative actions, effectively maintaining the status quo where traditional Medicare (Parts A and B) remains the default unless individuals opt into MA.
Potential Impacts
- On Government Agencies: HHS would be restricted in how it allocates budget for Medicare administration, potentially requiring reallocation of resources away from any default MA initiatives and toward traditional enrollment processes. This could increase administrative burdens for outreach and education on plan choices.
- On Citizens: Medicare-eligible individuals would be protected from unintended enrollment in private MA plans, preserving their ability to stay in traditional Medicare without active intervention. This may reduce confusion or financial risks for those unaware of auto-enrollment changes.
- On International Relations: No direct impacts, as this is a domestic health policy matter.
- Broader Effects: Private insurers offering MA plans might see slower growth in enrollment, while traditional Medicare spending could remain more stable.
Main Stakeholders Affected
- Medicare Beneficiaries: Primary group, including seniors and disabled individuals who rely on clear enrollment options to avoid unwanted private plan shifts.
- Department of Health and Human Services (HHS): Directly constrained in using funds for Medicare operations, affecting the Centers for Medicare & Medicaid Services (CMS), the agency that runs the program.
- Private Health Insurers: Companies providing MA plans could face reduced automatic enrollments, impacting their market share and revenue.
- Advocacy Groups and Lawmakers: Supporters (e.g., the bill's Democratic sponsors) represent interests favoring traditional Medicare; opponents may include those promoting privatization of health services.
- Taxpayers: Indirectly affected through federal spending priorities in Medicare, which is a major part of the U.S. budget.
Notable Legal, Constitutional, or Political Implications
- Legal: Relies on Congress's "power of the purse" (constitutional authority over appropriations) to influence executive branch actions without altering statutes, a tactic often used in divided government to block regulations. It could face challenges if HHS argues it infringes on administrative discretion, but courts generally uphold such funding restrictions.
- Constitutional: Aligns with separation of powers, as Congress controls spending; no apparent free speech or due process issues.
- Political: Reflects partisan divides on Medicare's future—critics of MA expansion see it as a way to limit privatization and protect public options, while proponents argue it hinders cost-saving innovations in private plans. As an introduced bill (not yet passed), it signals ongoing debates in the 119th Congress over health care funding and reform.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (16)
Rep. Carson, André [D-IN-7], Rep. Cohen, Steve [D-TN-9], Rep. DeLauro, Rosa L. [D-CT-3], Rep. Doggett, Lloyd [D-TX-37], Rep. Jayapal, Pramila [D-WA-7], Rep. Khanna, Ro [D-CA-17], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Ocasio-Cortez, Alexandria [D-NY-14], Rep. Schakowsky, Janice D. [D-IL-9], Rep. Takano, Mark [D-CA-39], Rep. Thanedar, Shri [D-MI-13], Rep. Tlaib, Rashida [D-MI-12], Rep. McBride, Sarah [D-DE-At Large], Rep. Omar, Ilhan [D-MN-5], Rep. Dingell, Debbie [D-MI-6], Rep. Casar, Greg [D-TX-35]
Recent Actions
- 2025-11-18: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-11-18: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-11-18: Introduced in House
- 2025-11-18: Introduced in House
Bill Versions
- To prohibit funds made available to the Department of Health and Human Services by previous Appropriations Acts from being used for any activity that makes Medicare Advantage the default under the Medicare program. — issued 2025-11-18 — PDF (2 pages)