To amend the Patient Protection and Affordable Care Act to establish a public health insurance option.

Amends the Patient Protection and Affordable Care Act to require the Secretary of Health and Human Services (HHS) to offer through Exchanges a health benefits plan (public health insurance option) that ensures choice, competition, and stability of affordable, high-quality coverage throughout the United States. Declares that the Secretary's primary responsibility is to create a low-cost plan without compromising quality or access to care.

Sets forth provisions related to the establishment and governance of the public health insurance option, including that such plan: (1) may be made available only through Exchanges; (2) must comply with requirements applicable to other health benefits plans offered through such Exchanges, including requirements related to benefits, benefit levels, provider networks, notices, consumer protections, and cost sharing; and (3) must offer bronze, silver, and gold plan levels.

Requires the Secretary to: (1) establish an office of the ombudsman for the public health insurance option; (2) collect such data as may be required to establish premiums and payment rates; (3) establish geographically adjusted premiums at a level sufficient to fully finance the costs of the health benefits provided and administrative costs related to the operation of the plan; and (4) establish payment rates and provide for greater payment rates for the first three years.

Requires repayment of start-up costs for the public health insurance option.

Authorizes the Secretary to utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option.