No official summary available for this bill.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6512 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 6512
To Empower American Families with Direct Control Over Healthcare
Dollars, Codify President Trump's Proven Reforms for Flexibility and
Choice, Prohibit Taxpayer Funding for Abortion and Gender Transition
Procedures, Eliminate Waste and Fraud in the Affordable Care Act, and
Reject Extensions of Enhanced Subsidies to Insurance Companies.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 9, 2025
Mr. Biggs of Arizona (for himself, Mr. Ogles, and Mr. Clyde) introduced
the following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Ways and Means,
Education and Workforce, and the Judiciary, 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
_______________________________________________________________________
A BILL
To Empower American Families with Direct Control Over Healthcare
Dollars, Codify President Trump's Proven Reforms for Flexibility and
Choice, Prohibit Taxpayer Funding for Abortion and Gender Transition
Procedures, Eliminate Waste and Fraud in the Affordable Care Act, and
Reject Extensions of Enhanced Subsidies to Insurance Companies.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Putting Patients First Healthcare
Freedom Act''
SEC. 2. TABLE OF CONTENTS.
The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--PUTTING PATIENTS OVER HEALTH INSURANCE COMPANIES
Subtitle A--More Affordable Care Act
Sec. 1001. Short title.
Sec. 1002. Health freedom waiver program.
Sec. 1003. Trump health freedom accounts.
Subtitle B--Improving HSA Access, Utility, and Flexibility
Sec. 1011. Individuals entitled to part A of medicare by reason of age
allowed to contribute to health savings
account.
Sec. 1012. Allow both spouses to make catch-up contributions to the
same health savings account.
Sec. 1013. FSA and HRA terminations or conversions to fund HSAs.
Sec. 1014. Special rule for certain medical expenses incurred before
establishment of health savings account.
Sec. 1015. Contributions permitted if spouse has health flexible
spending arrangement.
Sec. 1016. Increase in health savings account contribution limitation
for certain individuals.
Sec. 1017. Health savings accounts used to purchase insurance.
Subtitle C--Health Care Sharing Ministries
Sec. 1018. Treatment of health care sharing ministries.
Sec. 1019. Health care sharing ministry fees treated as medical care.
Sec. 1020. Health care sharing ministries not treated as health
insurance.
TITLE II--CODIFYING TRUMP HEALTHCARE FREEDOM AGENDA
Subtitle A--Association Health Plans Act
Sec. 2001. Short title.
Sec. 2002. Treatment of group or association of employers.
Sec. 2003. Rules applicable to employee welfare benefit plans
established and maintained by a group or
association of employers.
Sec. 2004. Rule of construction.
Subtitle B--CHOICE Arrangement Act
Sec. 2011. Short title.
Sec. 2012. Treatment of health reimbursement arrangements integrated
with individual market coverage.
Sec. 2013. Participants in choice arrangement eligible for purchase of
exchange insurance for purchase of
cafeteria plan.
Sec. 2014. Employer credit for choice arrangement.
Subtitle C--Self-Insurance Protection Act
Sec. 2021. Short title.
Sec. 2022. Findings.
Sec. 2023. Certain medical stop-loss insurance obtained by certain plan
sponsors of group health plans not included
under the definition of health insurance
coverage.
Sec. 2024. Effect on other laws.
Subtitle D--Small Business Flexibility Act
Sec. 2031. Short title.
Sec. 2032. Notification of flexible health insurance benefits.
Subtitle E--Health Coverage Choice Act
Sec. 2041. Short title.
Sec. 2042. Definition of short-term limited duration insurance.
Subtitle F--IMPACT Act of 2025
Sec. 2051. Short title.
Sec. 2052. Expanding eligibility for catastrophic plans.
Subtitle G--New Health Options Act
Sec. 2061. Short title.
Sec. 2062. Creation of a reinsurance program for a new health insurance
risk pool.
Sec. 2062. Promotion of high-value care.
Sec. 2064. Disclosure of lower prices.
Subtitle H--Fighting Waste Fraud and Abuse in the Unaffordable Care Act
Sec. 2071. Short title.
Sec. 2072. Addressing waste, fraud, and abuse in the ACA exchanges.
Sec. 2073. Funding cost-sharing reduction payments.
TITLE III--ENDING TAXPAYER FUNDING FOR ABORTION AND GENDER TRANSITION
PROCEDURES
Subtitle A--No Taxpayer Funding for Abortion and Abortion Insurance
Full Disclosure Act of 2025
Sec. 3000. Applicability to entire act.
Sec. 3001. Short title.
Sec. 3002. Prohibiting taxpayer funded abortions.
Sec. 3003. Amendment to table of chapters.
Sec. 3004. Clarifying application of prohibition to premium credits and
cost-sharing reductions under aca.
Sec. 3005. Revision to notice requirements regarding disclosure of
extent of health plan coverage of abortion
and abortion premium surcharges.
Subtitle B--Prohibiting Federal Funding for Gender Transition
Procedures
Sec. 3006. Short title.
Sec. 3007. Prohibiting Federal funding for gender transition
procedures.
TITLE I--PUTTING PATIENTS OVER HEALTH INSURANCE COMPANIES
Subtitle A--More Affordable Care Act
SEC. 1001. SHORT TITLE.
This Act may be cited as the ``More Affordable Care Act''.
SEC. 1002. HEALTH FREEDOM WAIVER PROGRAM.
Part 4 of subtitle D of title I of the Patient Protection and
Affordable Care Act (42 U.S.C. 18051 et seq.) is amended by adding the
following:
``SEC. 1335. HEALTH FREEDOM WAIVER PROGRAM.
``(a) In General.--
``(1) Waiver program.--The Secretary shall waive all or any
requirements described in paragraph (4), as determined by the
applicable State, for plan years beginning on or after January
1, 2026, with respect to health insurance coverage within any
State that submits a notification under paragraph (2), provided
that the State maintains an invisible high-risk insurance pool
or another program designed to mitigate risk to insurance
premium costs.
``(2) Notification.--A State entity described in paragraph
(3) desiring a waiver under this section for any plan year
beginning on or after January 1, 2026, shall notify the
Secretary of its intent to participate in the waiver program
with respect to all or any requirements described in paragraph
(4). Such notification shall be filed at such time, not later
than 90 days before the State intends to begin participation in
the waiver program, and in such manner as the Secretary may
require, and contain such information as the Secretary may
require, including the requirements under paragraph (4) that
the State intends to waiver and evidence that the State
maintains a high-risk insurance pool.
``(3) State submission.--A notification with respect to a
State may be submitted by--
``(A) the governor of the State; or
``(B) the legislature of the State, upon a majority
vote by the State legislature.
``(4) Requirements.--The requirements described in this
paragraph with respect to health insurance coverage within the
State are as follows:
``(A) Part 1 of subtitle D.
``(B) Part 2 of subtitle D.
``(C) Section 1402.
``(D) Sections 36B and 5000A of the Internal
Revenue Code of 1986.
``(5) Money follows the person.--
``(A) In general.--With respect to a State waiver
under paragraph (1), under which, due to the structure
of the State plan, individuals and small employers in
the State would not qualify for the premium tax
credits, cost-sharing reductions, or small business
credits under sec. 36B of the Internal Revenue Code of
1986 or under part I of subtitle E for which they would
otherwise be eligible, the Secretary shall provide for
an alternative means by which the aggregate amount of
such credits or reductions that would have been paid on
behalf of participants in the Exchanges established
under this title had the State not received such
waiver, shall be paid into the Trump Health Freedom
Accounts established under section 223(i) of the
Internal Revenue Code of 1986 of eligible residents of
the State.
``(B) Payments to trump health freedom accounts.--
The Secretary shall pay into the Trump Health Freedom
Accounts of each eligible resident of a State for which
a waiver is in effect for a play year the amount equal
to the total amount for which the resident would have
been eligible in premium tax credit amounts under
section 36B of the Internal Revenue Code of 1986 and
cost-sharing reduction amounts under section 1402 for
the year, had the State not had such waiver in effect.
In determining the appropriate payment amount under
this subparagraph, the Secretary shall calculate
premium tax credit amounts and cost-sharing reduction
amounts based on the national average annual premium
amount for a silver tier benchmark plan among States
that do not have such waivers in effect for the
applicable year. The Secretary shall make payments into
the Trump Health Freedom Accounts of eligible residents
on a monthly basis, quarterly basis, or in one lump sum
at the beginning of the year, at the option of each
eligible resident.
``(6) Coordinated waiver process.--The Secretary shall
develop a process for coordinating and consolidating the State
waiver processes applicable under the provisions of this
section, and the existing waiver processes applicable under
section 1332, and titles XVIII, XIX, and XXI of the Social
Security Act, and any other Federal law relating to the
provision of health care items or services. Such processes
shall permit a State to submit a single application for a
waiver under any or all of such provisions.
``(7) Exchanges.--
``(A) In general.--In the case of a State in which
a waiver is in effect under this section for a plan
year--
``(i) the State may--
``(I) operate an Exchange
established as described in section
1311(b); or
``(II) allow one or more private
entities to run commercial platforms
that sell health plans approved by the
State insurance commissioner; or
``(ii) if the State does not operate an
Exchange as described in clause (i)(I) or allow
for one or more commercial platforms described
in clause (i)(II), the Secretary shall operate
a Federal Exchange, as described in section
1321(c), provided that any State laws regarding
the availability of health plans on, and the
operation of, such Exchange shall apply in lieu
of any provision under part 1 or part 2 that
such State has waived.
``(B) Application program interface.--The Secretary
shall make available to any State that allows for
commercial platforms described in subparagraph
(A)(i)(II), the application program interface used for
operating Federal and State Exchanges, for use by any
private entity running such a platform under State
authority.
``(8) Definitions.--In this section:
``(A) Eligible resident.--The term `eligible
resident' means, with respect to a State for which a
waiver is in effect under this section, a resident
who--
``(i) in the absence of such a waiver in
the State, would be eligible for a premium tax
credit under section 36B of the Internal
Revenue Code of 1986 or a cost-sharing
reduction under section 1402, if the resident
enrolled in a qualified health plan offered on
the Exchange of such State; and
``(ii) enrolls in a plan offered on the
Exchange described in paragraph (7) for the
applicable plan year.
``(B) Secretary.--The term `Secretary' means--
``(i) the Secretary of Health and Human
Services with respect to waivers relating to
the provisions described in subparagraph (A)
through (C) of paragraph (4); and
``(ii) the Secretary of the Treasury with
respect to waivers relating to the provisions
described in paragraph (4)(D).
``(b) Waiver Period.--Each waiver under this section shall be in
effect beginning on January 1 of the plan year for which a timely
notice is submitted by the State under subsection (a)(2), and
continuing until the entity of the State described in subparagraph (A)
or (B) of subsection (a)(3) that submitted the notification under
subsection (a)(2) submits to the Secretary a notification of intent to
discontinue participation in the waiver program under this section.
``(c) Limitation.--The Secretary may not permit a waiver under this
section of any Federal law or requirement that is not within the
authority of the Secretary.
``(d) Availability of Plans.--
``(1) In general.--Any health insurance coverage offered in
a State for which a waiver under this section is in effect, and
authorized by the insurance commissioner of the State, shall be
made available on, as applicable, the Federal or State Exchange
or commercial platforms described in subsection (a)(7), of all
States for which such a waiver is in effect, subject to the
laws of each such State.
``(2) Child-only plans.--In any State for which a waiver
under this section is in effect, a health insurance issuer may
offer a plan in which the only individuals eligible to enroll
are individuals who, as of the beginning of a plan year, have
not attained the age of 21.
``(e) Regulations.--Not later than 1 year after the date of
enactment of the More Affordable Care Act, the Secretary of Health and
Human Services, in coordination with the Secretary of the Treasury,
shall promulgate regulations to carry out this section.
``(f) Rule of Construction Regarding Consumer Protections,
Including the Pre-Existing Condition Protection.--Nothing in this
section shall be construed to allow a State to waive the requirements
of title XXVII of the Public Health Service Act, including sections
2701, 2702, 2703, 2704, 2705, 2706, 2711, 2712, and 2718 of such
Act.''.
SEC. 1003. TRUMP HEALTH FREEDOM ACCOUNTS.
(a) In General.--Section 223 of the Internal Revenue Code of 1986
is amended by adding at the end the following new subsection:
``(i) Trump health freedom accounts.--For
purposes of this section--
``(1) In general.--In the case of a Trump Health Freedom
Account, this section shall be applied as provided in
paragraphs (3) through (8).
``(2) Trump health freedom account.--The term `Trump Health
Freedom Account' means a health savings account (determined as
provided in this subsection) established by or on behalf of an
individual residing in a State for which a waiver under section
1335 of the Patient Protection and Affordable Care Act is in
effect which receives deposits of amounts transferred to the
individual pursuant to section 1335(a)(5) of such Act.
``(3) Eligible individual.--Any individual covered under a
health plan authorized to be made available on an Exchange by
section 1335(d) of such Act shall be treated as an eligible
individual.
``(4) Treatment of transferred contributions.--Amounts
transferred to a Trump Health Freedom Account pursuant to
section 1335(a)(5) of such Act shall not be taken into account
in determining the deduction allowed by subsection (a).
``(5) Account must be only hsa of individual.--
``(A) In general.--An individual who has a Trump
Health Freedom Account shall not be treated as an
eligible individual with respect to any health savings
account other than such Trump Health Freedom Account.
``(B) Rollover of existing account permitted.--An
individual on whose behalf a Trump Health Freedom
Account is established may roll over the balance of any
other health savings account of the individual to such
Trump Health Freedom Account according to the rule of
subsection (f)(5).
``(6) No rollovers permitted.--Except as provided in
paragraph (6)(B), subsection (f)(5) shall not apply and no
amount shall be contributed from a Trump Health Freedom Account
to any health saving account other than a Trump Health Freedom
Account.
``(7) Restriction on use of amounts.--No amounts in a Trump
Health Freedom Account may be used--
``(A) to pay premiums for a health plan that
covers--
``(i) gender transition procedures; or
``(ii) abortion; or
``(B) pay for any service described in clause (i)
or (ii) or subparagraph (A).
``(8) Definitions.--For purposes of paragraph (8)--
``(A) Gender transition procedure.--
``(i) In general.--The term `gender
transition procedure' means any hormonal or
surgical intervention for the purpose of gender
transition, including--
``(I) gonadotropin-releasing
hormone (GNRH) agonists or other
puberty-blocking or suppressing drugs
to stop or delay normal puberty;
``(II) testosterone, estrogen,
progesterone, or other androgens to an
individual at doses that are
superphysiologic to what would normally
be produced endogenously in a healthy
individual of the same age and sex;
``(III) castration;
``(IV) orchiectomy;
``(V) scrotoplasty;
``(VI) implantation of erection or
testicular prostheses;
``(VII) vasectomy;
``(VIII) hysterectomy;
``(IX) oophorectomy;
``(X) ovariectomy;
``(XI) reconstruction of the fixed
part of the urethra with or without a
metoidioplasty or a phalloplasty;
``(XII) metoidioplasty;
``(XIII) penectomy;
``(XIV) phalloplasty;
``(XV) vaginoplasty;
``(XVI) clitoroplasty;
``(XVII) vaginectomy;
``(XVIII) vulvoplasty;
``(XIX) reduction
thyrochondroplasty;
``(XX) chondrolaryngoplasty;
``(XXI) mastectomy;
``(XXII) tubal ligation;
``(XXIII) sterilization;
``(XXIV) any plastic, cosmetic, or
aesthetic surgery that feminizes or
masculinizes the facial or other
physiological features of an
individual;
``(XXV) any placement of chest
implants to create feminine breasts;
``(XXVI) any placement of fat or
artificial implants in the gluteal
region;
``(XXVII) augmentation mammoplasty;
``(XXVIII) liposuction;
``(XXIX) lipofilling;
``(XXX) voice surgery;
``(XXXI) hair reconstruction;
``(XXXII) pectoral implants; and
``(XXXIII) the removal of any
otherwise healthy or non-diseased body
part or tissue.
``(ii) Exclusions.--The term `gender
transition procedure' does not include the
following when furnished to an individual by a
health care provider with the consent of such
individual or, if applicable, such individual's
parents or legal guardian:
``(I) Services to individuals born
with a medically verifiable disorder of
sex development, including an
individual with external sex
characteristics that are irresolvably
ambiguous such as an individual born
with 46 XX chromosomes with
virilization, and individual born with
46 XY chromosomes with
undervirilization, or an individual
born having both ovarian and testicular
tissue.
``(II) Service provided when a
physician has otherwise diagnosed a
disorder of sexual development in which
the physician has determined through
genetic or biochemical testing that the
individual does not have normal sex
chromosome structure, sex steroid
hormone production, or sex steroid
hormone action for a healthy individual
of the same sex and age.
``(III) The treatment of any
infection, injury, disease, or disorder
that has been caused by or exacerbated
by the performance of gender transition
procedures, whether or not the gender
transition procedure was performed in
accordance with State and Federal law
or whether or not funding for the
gender transition procedure is
permissible under this section.
``(IV) Any procedure undertaken
because the individual suffers from a
physical disorder, physical injury, or
physical illness (but not mental,
behavioral, or emotional distress or a
mental, behavioral, or emotional
disorder) that would, as certified by a
physician, place the individual in
imminent danger of death or impairment
of major bodily function, unless the
procedure is performed.
``(V) Puberty suppression or
blocking prescription drugs for the
purpose of normalizing puberty for a
minor experiencing precocious puberty.
``(VI) Male circumcision.
``(B) Gender transition.--The term `gender
transition' means the process in which an individual
goes from identifying with or presenting as his or her
sex to identifying with or presenting a self-proclaimed
identity that does not correspond with or is different
from his or her sex and may be accompanied with social,
legal, or physical changes.
``(C) Sex.--The term `sex', when referring to an
individual's sex, means to refer to either male or
female, as biologically determined.
``(D) Female.--The term `female', when used to
refer to a natural person, means an individual who
naturally has, had, will have, or would have, but for a
congenital anomaly, historic accident, or intentional
or unintentional disruption, the reproductive system
that at some point produces, transports, and utilizes
eggs for fertilization.
``(E) Male.--The term `male', when used to refer to
a natural person, means an individual who naturally
has, had, will have, or would have, but for a
congenital anomaly, historical accident, or intentional
or unintentional disruption, the reproductive system
that at some point produces, transports, and utilizes
sperm for fertilization.
``(b) Effective Date.--The amendment made by this section shall
apply to taxable years beginning after December 31, 2025.''.
Subtitle B--Improving HSA Access, Utility, and Flexibility
SEC. 1011. INDIVIDUALS ENTITLED TO PART A OF MEDICARE BY REASON OF AGE
ALLOWED TO CONTRIBUTE TO HEALTH SAVINGS ACCOUNT.
(a) In General.--Section 223(c)(1)(B) is amended by striking
``and'' at the end of clause (ii), by striking the period at the end of
clause (iii) and inserting ``, and'', and by adding at the end the
following new clause:
``(iv) entitlement to hospital insurance
benefits under part A of title XVIII of the
Social Security Act by reason of section 226(a)
of such Act.''.
(b) Treatment of Health Insurance Purchased From Account.--Section
223(d)(2)(C)(iv) is amended by inserting ``and who is not an eligible
individual'' after ``who has attained the age specified in section 1811
of the Social Security Act''.
(c) Coordination With Penalty on Distributions Not Used for
Qualified Medical Expenses.--Section 223(f)(4)(C) is amended by
striking ``Subparagraph (A)'' and inserting ``Except in the case of an
eligible individual, subparagraph (A)''.
(d) Conforming Amendment.--Section 223(b)(7) is amended by
inserting ``(other than an entitlement to benefits described in
subsection (c)(1)(B)(iv))'' after ``Social Security Act''.
(e) Effective Date.--The amendments made by this section shall
apply to months beginning after December 31, 2025.
SEC. 1012. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CONTRIBUTIONS TO THE
SAME HEALTH SAVINGS ACCOUNT.
(a) In General.--Section 223(b)(5) is amended to read as follows:
``(5) Special rule for married individuals with family
coverage.--
``(A) In general.--In the case of individuals who
are married to each other, if both spouses are eligible
individuals and either spouse has family coverage under
a high deductible health plan as of the first day of
any month--
``(i) the limitation under paragraph (1)
shall be applied by not taking into account any
other high deductible health plan coverage of
either spouse (and if such spouses both have
family coverage under separate high deductible
health plans, only one such coverage shall be
taken into account),
``(ii) such limitation (after application
of clause (i)) shall be reduced by the
aggregate amount paid to Archer MSAs of such
spouses for the taxable year, and
``(iii) such limitation (after application
of clauses (i) and (ii)) shall be divided
equally between such spouses unless they agree
on a different division.
``(B) Treatment of additional contribution
amounts.--If both spouses referred to in subparagraph
(A) have attained age 55 before the close of the
taxable year, the limitation referred to in
subparagraph (A)(iii) which is subject to division
between the spouses shall include the additional
contribution amounts determined under paragraph (3) for
both spouses. In any other case, any additional
contribution amount determined under paragraph (3)
shall not be taken into account under subparagraph
(A)(iii) and shall not be subject to division between
the spouses.''.
(b) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2025.
SEC. 1013. FSA AND HRA TERMINATIONS OR CONVERSIONS TO FUND HSAS.
(a) In General.--Section 106(e)(2) is amended to read as follows:
``(2) Qualified hsa distribution.--For purposes of this
subsection--
``(A) In general.--The term `qualified HSA
distribution' means, with respect to any employee, a
distribution from a health flexible spending
arrangement or health reimbursement arrangement of such
employee contributed directly to a health savings
account of such employee if--
``(i) such distribution is made in
connection with such employee establishing
coverage under a high deductible health plan
(as defined in section 223(c)(2)) if during the
4-year period preceding the date the employee
so establishes coverage the employee was not
covered under such a high deductible health
plan, and
``(ii) such arrangement is described in
section 223(c)(1)(B)(v) with respect to any
portion of the plan year remaining after such
distribution is made, if such employee remains
enrolled in such arrangement.
``(B) Dollar limitation.--The aggregate amount of
distributions from health flexible spending
arrangements and health reimbursement arrangements of
any employee which may be treated as qualified HSA
distributions in connection with an establishment of
coverage described in subparagraph (A)(i) shall not
exceed the dollar amount in effect under section
125(i)(1) (twice such amount in the case of coverage
which is described in section 223(b)(2)(B)).''.
(b) Partial Reduction of Limitation on Deductible HSA
Contributions.--Section 223(b)(4) is amended by striking ``and'' at the
end of subparagraph (B), by striking the period at the end of
subparagraph (C) and inserting ``, and'', and by inserting after
subparagraph (C) the following new subparagraph:
``(D) so much of any qualified HSA distribution (as
defined in section 106(e)(2)) made to a health savings
account of such individual during the taxable year as
does not exceed the aggregate increases in the balance
of the arrangement from which such distribution is made
which occur during the portion of the plan year which
precedes such distribution (other than any balance
carried over to such plan year and determined without
regard to any decrease in such balance during such
portion of the plan year).''.
(c) Conversion to HSA-Compatible Arrangement for Remainder of Plan
Year.--Section 223(c)(1)(B), as amended by this preceding provisions of
this Act, is amended by striking ``and'' at the end of clause (iii), by
striking the period at the end of clause (iv) and inserting ``, and'',
and by adding at the end the following new clause:
``(v) coverage under a health flexible spending arrangement or
health reimbursement arrangement for the portion of the plan year after
a qualified HSA distribution (as defined in section 106(e)(2)
determined without regard to subparagraph (A)(ii) thereof) is made, if
the terms of such arrangement which apply for such portion of the plan
year are such that, if such terms applied for the entire plan year,
then such arrangement would not be taken into account under
subparagraph (A)(ii) of this paragraph for such plan year.''.
(d) Inclusion of Qualified HSA Distributions on W-2.--
(1) In general.--Section 6051(a), as amended by the
preceding provisions of this Act, is amended by striking
``and'' at the end of paragraph (19), by striking the period at
the end of paragraph (20) and inserting ``, and'', and by
inserting after paragraph (20) the following new paragraph:
``(21) the amount of any qualified HSA distribution (as
defined in section 106(e)(2)) with respect to such employee.''.
(2) Conforming amendment.--Section 6051(a)(12) is amended
by inserting ``(other than any qualified HSA distribution, as
defined in section 106(e)(2))'' before the comma at the end.
(e) Effective Date.--The amendments made by this section shall
apply to distributions made after December 31, 2025.
SEC. 1014. SPECIAL RULE FOR CERTAIN MEDICAL EXPENSES INCURRED BEFORE
ESTABLISHMENT OF HEALTH SAVINGS ACCOUNT.
(a) In General.--Section 223(d)(2), as amended by the preceding
provisions of this Act, is amended by adding at the end the following
new subparagraph:
``(F) Treatment of certain medical expenses
incurred before establishment of account.--If a health
savings account is established during the 60-day period
beginning on the date that coverage of the account
beneficiary under a high deductible health plan begins,
then, solely for purposes of determining whether an
amount paid is used for a qualified medical expense,
such account shall be treated as having been
established on the date that such coverage begins.''.
(b) Effective Date.--The amendment made by this section shall apply
with respect to coverage beginning after December 31, 2025.
SEC. 1015. CONTRIBUTIONS PERMITTED IF SPOUSE HAS HEALTH FLEXIBLE
SPENDING ARRANGEMENT.
(a) Contributions Permitted if Spouse Has a Health Flexible
Spending Arrangement.--Section 223(c)(1)(B), as amended by this
preceding provisions of this Act, is amended by striking ``and'' at the
end of clause (iv), by striking the period at the end of clause (v) and
inserting ``, and'', and by adding at the end the following new clause:
``(vi) coverage under a health flexible
spending arrangement of the spouse of the
individual for any plan year of such
arrangement if the aggregate reimbursements
under such arrangement for such year do not
exceed the aggregate expenses which would be
eligible for reimbursement under such
arrangement if such expenses were determined
without regard to any expenses paid or incurred
with respect to such individual.''.
(b) Effective Date.--The amendment made by this section shall apply
to plan years beginning after December 31, 2025.
SEC. 1016. INCREASE IN HEALTH SAVINGS ACCOUNT CONTRIBUTION LIMITATION
FOR CERTAIN INDIVIDUALS.
(a) Increase.--
(1) In general.--Section 223(b) is amended by adding at the
end the following new paragraph:
``(9) Increase in limitation for certain taxpayers.--
``(A) In general.--The applicable limitation under
subparagraphs (A) and (B) of paragraph (2) shall be
increased by $4,300 and $8,550, respectively.
``(B) Limitation based on modified adjusted gross
income.--The amount of the increase under subparagraph
(A) (determined without regard to this subparagraph)
shall be reduced (but not below zero) by the amount
which bears the same ratio to the amount of such
increase (as so determined) as--
``(i) the excess (if any) of--
``(I) the taxpayer's adjusted gross
income for such taxable year, over
``(II) $75,000 ($150,000 in the
case of a joint return, if the eligible
individual has family coverage), bears
to
``(ii) $25,000 ($50,000 in the case of a
joint return, if the eligible individual has
family coverage).
For purposes of the preceding sentence, adjusted gross
income shall be determined in the same manner as under
section 219(g)(3)(A), except determined without regard
to any deduction allowed under this section.''.
(2) Only to apply to employee contributions.--Section
106(d)(1) is amended by inserting ``and section 223(b)(9)''
after ``determined without regard to this subsection''.
(b) Inflation Adjustment.--Section 223(g), as amended by the
preceding provisions of this Act, is amended--
(1) by inserting ``, (b)(9)(A), (b)(9)(B)(i)(II),'' before
``and (c)(2)(A)'' each place it appears,
(2) by striking ``clauses (ii) and (ii)'' in paragraph
(1)(B)(i) and inserting ``clauses (ii), (iii), and (iv)'',
(3) by striking ``and'' at the end of paragraph (1)(B)(ii),
(4) by striking the period at the end of paragraph
(1)(B)(iii) and inserting ``, and'', and
(5) by inserting after paragraph (1)(B)(iii) the following
new clause:
``(iv) in the case of the dollar amounts in
subsections (b)(9)(A) and (b)(9)(B)(i)(II),
calendar year 2025''.
(c) Effective Date.--
(1) Subsection (a).--The amendments made by subsection (a)
shall apply to taxable years beginning after December 31, 2025.
(2) Subsection (b).--The amendments made by subsection (b)
shall apply to taxable years beginning after December 31, 2026.
SEC. 1017. HEALTH SAVINGS ACCOUNTS USED TO PURCHASE INSURANCE.
(a) In General.--Section 223(d)(2) of the Internal Revenue Code of
1986 is amended--
(1) by striking subparagraphs (B) and (C), and
(2) by redesignating subparagraph (D) as subparagraph (C).
(b) Effective Date.--The amendment made by this section shall apply
to plan years beginning after December 31, 2025.
Subtitle C--Health Care Sharing Ministries
SEC. 1018. TREATMENT OF HEALTH CARE SHARING MINISTRIES.
(a) Inclusion as Medical Expenses.--Paragraph (2) of section 223(c)
of the Internal Revenue Code of 1986, as redesignated and amended by
the preceding provisions of this Act, is further amended by adding at
the end the following new subparagraph:
``(D) Inclusion of health care sharing
ministries.--The term `qualified medical expenses'
shall include amounts paid by a member of a health care
sharing ministry (as defined in section
5000A(d)(2)(B)(ii) without regard to subclause (IV)
thereof) for--
``(i) the sharing of medical expenses among
members, and
``(ii) administrative fees of the
ministry.''.
(b) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of enactment of this
Act.
SEC. 1019. HEALTH CARE SHARING MINISTRY FEES TREATED AS MEDICAL CARE.
(a) In General.--Section 213(d) of the Internal Revenue Code of
1986 is amended by adding at the end the following new paragraph:
``(12) Health care sharing ministries.--For purposes of
this section, the term `medical care' shall include amounts
paid by a member of a health care sharing ministry (as defined
in section 5000A(d)(2)(B)(ii) without regard to subclause (IV)
thereof) for--
``(A) the sharing of medical expenses among
members, and
``(B) administrative fees of the ministry.''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after the date of the enactment of this Act.
SEC. 1020. HEALTH CARE SHARING MINISTRIES NOT TREATED AS HEALTH
INSURANCE.
(a) In General.--Section 223(c) of the Internal Revenue Code of
1986, as redesignated and amended by the preceding provisions of this
Act, is amended by adding at the end the following new paragraph:
``(5) Health care sharing ministries not treated as health
insurance.--A health care sharing ministry (as defined in
section 5000A(d)(2)(B)(ii) without regard to subclause (IV)
thereof) shall not be treated as health plan or insurance for
purposes of this title.''.
(b) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of enactment of this
Act.
TITLE II--CODIFYING TRUMP HEALTHCARE FREEDOM AGENDA
Subtitle A--Association Health Plan Act
SEC. 2001. SHORT TITLE.
This Act may be cited the ``Association Health Plan Act''.
SEC. 2002. TREATMENT OF GROUP OR ASSOCIATION OF EMPLOYERS.
(a) In General.--Section 3(5) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1002(5)) is amended--
(1) by striking ``The term'' and inserting ``(A) The
term''; and
(2) by adding at the end the following:
``(B) For purposes of subparagraph (A), a group or
association of employers shall be treated as an
`employer', regardless of whether the employers
composing such group or association are in the same
industry, trade, or profession, if such group or
association--
``(i)(I) has established and maintains an
employee welfare benefit plan that is a group
health plan (as defined in section 733(a)(1));
``(II) provides coverage under such
plan to at least 51 employees after all
of the employees employed by all of the
employer members of such group or
association have been aggregated and
counted together as described in
subparagraph (D);
``(III) has been actively in
existence for at least 2 years;
``(IV) has been formed and
maintained in good faith for purposes
other than providing medical care (as
defined in section 733(a)(2)) through
the purchase of insurance or otherwise;
``(V) does not condition membership
in the group or association on any
health status-related factor (as
described in section 702(a)(1))
relating to any individual;
``(VI) makes coverage under such
plan available to all employer members
of such group or association regardless
of any health status-related factor (as
described in section 702(a)(1))
relating to such employer members;
``(VII) does not provide coverage
under such plan to any individual other
than an employee of an employer member
of such group or association;
``(VIII) has established a
governing board with by-laws or other
similar indications of formality to
manage and operate such plan in both
form and substance, of which at least
75 percent of the board members shall
be made up of employer members of such
group or association participating in
the plan that are duly elected by each
participating employer member casting 1
vote during a scheduled election;
``(IX) is not a health insurance
issuer (as defined in section
733(b)(2)), and is not owned or
controlled by such a health insurance
issuer or by a subsidiary or affiliate
of such a health insurance issuer,
other than to the extent such a health
insurance issuer may participate in the
group or association as a member;
``(ii) is structured in good faith with any
set of criteria to qualify for such treatment
in any advisory opinion issued prior to the
date of enactment of the Association Health
Plans Act; or
``(iii) meets any other set of criteria to
qualify for such treatment that the Secretary
by regulation may provide.
``(C)(i) For purposes of subparagraph (B), a self-
employed individual shall be treated as--
``(I) an employer who may become a
member of a group or association of
employers;
``(II) an employee who may
participate in an employee welfare
benefit plan established and maintained
by such group or association; and
``(III) a participant of such plan
subject to the eligibility
determination and monitoring
requirements set forth in clause (iii).
``(ii) For purposes of this subparagraph,
the term `self-employed individual' means an
individual who--
``(I) does not have any common law
employees;
``(II) has a bona fide ownership
right in a trade or business,
regardless of whether such trade or
business is incorporated or
unincorporated;
``(III) earns wages (as defined in
section 3121(a) of the Internal Revenue
Code of 1986) or self-employment income
(as defined in section 1402(b) of such
Code) from such trade or business; and
``(IV) works at least 10 hours a
week or 40 hours per month providing
personal services to such trade or
business.
``(iii) The board of a group or association
of employers shall--
``(I) initially determine whether
an individual meets the requirements
under clause (ii) to be considered to a
self-employed individual for the
purposes of being treated as an--
``(aa) employer member of
such group or association (in
accordance with clause (i)(I));
and
``(bb) employee who may
participate in the employee
welfare benefit plan
established and maintained by
such group or association (in
accordance with clause
(i)(II));
``(II) through reasonable
monitoring procedures, periodically
determine whether the individual
continues to meet such requirements;
and
``(III) if the board determines
that an individual no longer meets such
requirements, not make such plan
coverage available to such individual
(or dependents thereof) for any plan
year following the plan year during
which the board makes such
determination. If, subsequent to a
determination that an individual no
longer meets such requirements, such
individual furnishes evidence of
satisfying such requirements, such
individual (and dependents thereof)
shall be eligible to receive plan
coverage.
``(D) For purposes of subparagraph (B), all of the
employees (including self-employed individuals)
employed by all of the employer members (including
self-employed individuals) of a group or association of
employers shall be--
``(i) treated as participants in a single
plan multiple employer welfare arrangement; and
``(ii) aggregated and counted together for
purposes of any regulation of an employee
welfare benefit plan established and maintained
by such group or association.''.
(b) Determination of Employer or Joint Employer Status.--The
provision of employee welfare benefit plan coverage by a group or
association of employers shall not be construed as evidence for
establishing an employer or joint employer relationship under any
Federal or State law.
SEC. 2003. RULES APPLICABLE TO EMPLOYEE WELFARE BENEFIT PLANS
ESTABLISHED AND MAINTAINED BY A GROUP OR ASSOCIATION OF
EMPLOYERS.
Part 7 of subtitle B of title I of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1181, et seq.) is amended by adding at
the end the following:
``SEC. 736. RULES APPLICABLE TO EMPLOYEE WELFARE BENEFIT PLANS
ESTABLISHED AND MAINTAINED BY A GROUP OR ASSOCIATION OF
EMPLOYERS.
``(a) Premium Rates for a Group or Association of Employers.--
``(1)(A) In the case of an employee welfare benefit plan
established and maintained by a group or association of
employers described in section 3(5)(B), such plan may, to the
extent not prohibited under State law--
``(i) establish base premium rates formed
on an actuarially sound, modified community
rating methodology that considers the pooling
of all plan participant claims; and
``(ii) utilize the specific risk profile of
each employer member of such group or
association to determine contribution rates for
each such employer member's share of a premium
by actuarially adjusting above or below the
established base premium rates.
``(B) For purposes of paragraph (1), the term
`employer member' means--
``(i) an employer who is a member of such
group or association of employers and employs
at least 1 common law employee; or
``(ii) a group made up solely of self-
employed individuals, within which all of the
self-employed individual members of such group
or association are aggregated together as a
single employer member group, provided the
group includes at least 20 self-employed
individual members.
``(2) In the event a group or association is made up solely
of self-employed individuals (and no employers with at least 1
common law employee are members of such group or association),
the employee welfare benefit plan established by such group or
association shall--
``(A) treat all self-employed individuals who are
members of such group or association as a single risk
pool;
``(B) pool all plan participant claims; and
``(C) charge each plan participant the same premium
rate.
``(b) Discrimination and Pre-Existing Condition Protections.--An
employee welfare benefit plan established and maintained by a group or
association of employers described in section 3(5)(B) shall be
prohibited from--
``(1) establishing any rule for eligibility (including
continued eligibility) of any individual (including an employee
of an employer member or a self-employed individual, or a
dependent of such employee or self-employed individual) to
enroll for benefits under the terms of the plan that
discriminates based on any health status-related factor that
relates to such individual (consistent with the rules under
section 702(a)(1));
``(2) requiring an individual (including an employee of an
employer member or a self-employed individual, or a dependent
of such employee or self-employed individual), as a condition
of enrollment or continued enrollment under the plan, to pay a
premium or contribution that is greater than the premium or
contribution for a similarly situated individual enrolled in
the plan based on any health status-related factor that relates
to such individual (consistent with the rules under section
702(b)(1)); and
``(3) denying coverage under such plan on the basis of a
pre-existing condition (consistent with the rules under section
2704 of the Public Health Service Act).''.
SEC. 2004. RULE OF CONSTRUCTION.
Nothing in this Act shall be construed to exempt a group health
plan which is an employee welfare benefit plan offered through a group
or association of employers from the requirements of part 7 of subtitle
B of title I of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1181 et. seq.), including the provisions of part A of title
XXVII of the Public Health Service Act as incorporated by reference
into this Act through section 715.
Subtitle B--CHOICE Arrangement Act
SEC. 2011. SHORT TITLE.
This Act may be cited as the ``CHOICE Arrangement Act''.
SEC. 2012. TREATMENT OF HEALTH REIMBURSEMENT ARRANGEMENTS INTEGRATED
WITH INDIVIDUAL MARKET COVERAGE.
(a) In General.--Section 9815(b) is amended--
(1) By striking ``exception Notwithstanding subsection
(a)'' and inserting the following: ``Exceptions.--
``(1) Self-insured group health plans.--Notwithstanding
subsection (a)''
(2) by adding at the end the following new paragraph:
``(2) Custom health option and individual care expense
arrangements.--
``(A) In general.--For purposes of this subchapter,
a custom health option and individual care expense
arrangement shall be treated as meeting the
requirements of section 9802 and sections 2705, 2711,
2713, and 2715 of title XXVII of the Public Health
Service Act.
``(B) Custom health option and individual care
expense arrangements defined.--For purposes of this
section, the term `custom health option and individual
care expense arrangement' means a health reimbursement
arrangement--
``(i) which is an employer-provided group
health plan funded solely by employer
contributions to provide payments or
reimbursements for medical care subject to a
maximum fixed dollar amount for a period,
``(ii) under which such payments or
reimbursements may only be made for medical
care provided during periods during which the
individual is covered--
``(I) under individual health
insurance coverage (other than coverage
that consists solely of excepted
benefits), or
``(II) under part A and B of title
XVIII of the Social Security Act or
part C of such title,
``(iii) which meets the nondiscrimination
requirements of subparagraph (C),
``(iv) which meets the substantiation
requirements of subparagraph (D), and
``(v) which meets the notice requirements
of subparagraph (E).
``(C) Nondiscrimination.--
``(i) In general.--An arrangement meets the
requirements of this subparagraph if an
employer offering such arrangement to an
employee within a specified class of employee--
``(I) offers such arrangement to
all employees within such specified
class on the same terms, and
``(II) does not offer any other
group health plan (other than an
account-based group health plan or a
group health plan that consists solely
of excepted benefits) to any employees
within such specified class.
In the case of an employer who offers a group
health plan provided through health insurance
coverage in the small group market (that is
subject to section 2701 of the Public Health
Service Act) to all employees within such
specified class, subclause (II) shall not apply
to such group health plan.
``(ii) Specified class of employee.--For
purposes of this subparagraph, any of the
following may be designated as a specified
class of employee:
``(I) Full-time employees.
``(II) Part-time employees.
``(III) Salaried employees.
``(IV) Non-salaried employees.
``(V) Employees whose primary site
of employment is in the same rating
area.
``(VI) Employees who are included
in a unit of employees covered under a
collective bargaining agreement to
which the employer is subject
(determined under rules similar to the
rules of section 105(h)).
``(VII) Employees who have not met
a group health plan, or health
insurance issuer offering group health
insurance coverage, waiting period
requirement that satisfies section 2708
of the Public Health Service Act.
``(VIII) Seasonal employees.
``(IX) Employees who are
nonresident aliens and who receive no
earned income (within the meaning of
section 911(d)(2)) from the employer
which constitutes income from sources
within the United States (within the
meaning of section 861(a)(3)).
``(X) Such other classes of
employees as the Secretary may
designate.
An employer may designate (in such manner as is
prescribed by the Secretary) two or more of the
classes described in the preceding subclauses
as the specified class of employees to which
the arrangement is offered for purposes of
applying this subparagraph.
``(iii) Special rule for new hires.--An
employer may designate prospectively so much of
a specified class of employees as are hired
after a date set by the employer. Such subclass
of employees shall be treated as the specified
class for purposes of applying clause (i).
``(iv) Rules for determining type of
employee.--For purposes for clause (ii), any
determination of full-time, part-time, or
seasonal employment status shall be made under
rules similar to the rules of section 105(h) or
4980H, whichever the employer elects for the
plan year. Such election shall apply with
respect to all employees of the employer for
the plan year.
``(v) Permitted variation.--For purposes of
clause (i)(I), an arrangement shall not fail to
be treated as provided on the same terms within
a specified class merely because the maximum
dollar amount of payments and reimbursements
which may be made under the terms of the
arrangement for the year with respect to each
employee within such class--
``(I) increases as additional
dependents of the employee are covered
under the arrangement, and
``(II) increases with respect to a
participant as the age of the
participant increases, but not in
excess of an amount equal to 300
percent of the lowest maximum dollar
amount with respect to such a
participant determined without regard
to age.
``(D) Substantiation requirements.--An arrangement
meets the requirements of this subparagraph if the
arrangement has reasonable procedures to substantiate--
``(i) that the participant and any
dependents are, or will be, enrolled in
coverage described in subparagraph (B)(ii) as
of the beginning of the plan year of the
arrangement (or as of the beginning of coverage
under the arrangement in the case of an
employee who first becomes eligible to
participate in the arrangement after the date
notice is given with respect to the plan under
subparagraph (E) (determined without regard to
clause (iii) thereof)), and
``(ii) any requests made for payment or
reimbursement of medical care under the
arrangement and that the participant and any
dependents remain so enrolled.
``(E) Notice.--
``(i) In general.--Except as provided in
clause (iii), an arrangement meets the
requirements of this subparagraph if, under the
arrangement, each employee eligible to
participate is, not later than 60 days before
the beginning of the plan year, given written
notice of the employee's rights and obligations
under the arrangement which--
``(I) is sufficiently accurate and
comprehensive to apprise the employee
of such rights and obligations, and
``(II) is written in a manner
calculated to be understood by the
average employee eligible to
participate.
``(ii) Notice requirements.--Such notice
shall include such information as the Secretary
may by regulation prescribe.
``(iii) Notice deadline for certain
employees.--In the case of an employee--
``(I) who first becomes eligible to
participate in the arrangement after
the date notice is given with respect
to the plan under clause (i)
(determined without regard to this
clause), or
``(II) whose employer is first
established fewer than 120 days before
the beginning of the first plan year of
the arrangement,
the requirements of this subparagraph shall be
treated as met if the notice required under
clause (i) is provided not later than the date
the arrangement may take effect with respect to
such employee.''.
(b) Inclusion of CHOICE Arrangement Permitted Benefits on W-2.--
(1) In general.--Section 6051(a), as amended by the
preceding provisions of this Act, is amended by striking
``and'' at the end of paragraph (18), by striking the period at
the end of paragraph (19) and inserting ``, and'', and by
inserting after paragraph (19) the following new paragraph:
``(20) the total amount of permitted benefits for enrolled
individuals under a custom health option and individual care
expense arrangement (as defined in section 9815(b)(2)) with
respect to such employee.''.
(c) Treatment of Current Rules Relating to Certain Arrangements.--
(1) No inference.--To the extent not inconsistent with the
amendments made by this section--
(A) no inference shall be made from such amendments
with respect to the rules prescribed in the Federal
Register on June 20, 2019 (84 Fed. Reg. 28888),
relating to health reimbursement arrangements and other
account-based group health plans, and
(B) any reference to custom health option and
individual care expense arrangements shall for purposes
of such rules be treated as including a reference to
individual coverage health reimbursement arrangements.
(2) Other conforming of rules.--The Secretary of the
Treasury, the Secretary of Health and Human Services, and the
Secretary of Labor shall modify such rules as may be necessary
to conform to the amendments made by this section.
(d) Effective Date.--The amendments made by this section shall
apply to plan years beginning after December 31, 2025.
SEC. 2013. PARTICIPANTS IN CHOICE ARRANGEMENT ELIGIBLE FOR PURCHASE OF
EXCHANGE INSURANCE FOR PURCHASE OF CAFETERIA PLAN.
(a) In General.--Section 125(f)(3) is amended by adding at the end
the following new subparagraph:
``(C) Exception for participants in choice
arrangement.--Subparagraph (A) shall not apply in the
case of an employee participating in a custom health
option and individual care expense arrangement (within
the meaning of section 9815(b)(2)) offered by the
employee's employer.''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after December 31, 2025.
SEC. 2014. EMPLOYER CREDIT FOR CHOICE ARRANGEMENT.
(a) In General.--Subpart D of part IV of subchapter A of chapter 1
is amended by adding at the end the following new section:
``SEC. 45BB. EMPLOYER CREDIT FOR CHOICE ARRANGEMENT.
``(a) In General.--For purposes of section 38, in the case of an
eligible employer, the CHOICE arrangement credit determined under this
section for any taxable year is an amount, with respect to each
employee enrolled during the credit period in a CHOICE arrangement
maintained by the employer, equal to--
``(1) $100 multiplied by the number of months for which the
employee is so enrolled during the first year in the credit
period, and
``(2) one-half of the dollar amount in effect under
paragraph (1) for the taxable year, multiplied by the number of
months for which the employee is so enrolled during the second
year of the credit period.
``(b) Arrangement Must Constitute Minimum Essential Coverage.--An
employee shall not be taken into account under subsection (a) unless
such employee's eligibility for the CHOICE arrangement (determined
without regard to the employee being enrolled) would cause the employee
to be treated under section 36B(c)(2) as being eligible for minimum
essential coverage consisting of an eligible employer-sponsored plan
(as defined in section 5000A(f)(2)).
``(c) Definitions.--For purposes of this section--
``(1) CHOICE arrangement.--The term `CHOICE arrangement'
means a custom health option and individual care expense
arrangement (as defined in section 9815(b)(2)(B)).
``(2) Credit period.--The credit period with respect to an
eligible employer is the first 2 one-year periods beginning
with the month during which the employer first establishes a
CHOICE arrangement on behalf of employees of the employer.
``(3) Eligible employer.--The term `eligible employer'
means, with respect to any taxable year beginning in a calendar
year, an employer who is not an applicable large employer for
the calendar year under section 4980H.
``(d) Inflation Adjustment.--
``(1) In general.--In the case of any taxable year
beginning in a calendar year after 2026, the dollar amount in
subsection (a) shall be increased by an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined
under section 1(f)(3) for the calendar year in which
such taxable year begins by substituting `calendar year
2025' for `calendar year 2016' in subparagraph (A)(ii)
thereof.
``(2) Rounding.--If any amount after adjustment under
paragraph (1) is not a multiple of $10, such amount shall be
rounded to the next lower multiple of $10.''.
(b) Credit Made Part of General Business Credit.--Section 38(b) is
amended by striking ``plus'' at the end of paragraph (40), by striking
the period at the end of paragraph (41) and inserting ``, plus'', and
by adding at the end the following new paragraph:
``(42) the CHOICE arrangement credit determined under
section 45BB(a).''.
(c) Credit Allowed Against Alternative Minimum Tax.--Section
38(c)(4)(B) is amended--
(1) by redesignating clauses (x), (xi), and (xii) as
clauses (xi), (xii), and (xiii), respectively, and
(2) by inserting after clause (ix) the following new
clause:
``(x) the credit determined under section
45BB,''.
(d) Clerical Amendment.--The table of sections for subpart D of
part IV of subchapter A of chapter 1 is amended by adding at the end
the following new item:
(e) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2025.
Subtitle C--Self-Insurance Protection Act
SEC. 2021. SHORT TITLE.
This Act may be cited as the ``Self-Insurance Protection Act''.
SEC. 2022. FINDINGS.
Congress finds the following:
(1) Small and large employers offer health benefit plan
coverage to employees in self-funded arrangements using company
assets or a fund, or by paying premiums to purchase fully-
insured coverage from a health insurance company.
(2) Employers that self-fund health benefit plans will
often purchase stop-loss insurance as a financial risk
management tool to protect against excess or unexpected
catastrophic health plan claims losses that arise above
projected costs paid out of company assets.
(3) Stop-loss coverage insures the employer sponsoring the
health benefit plan against unforeseen health plan claims, does
not insure the employee health benefit plan itself, and does
not pay health care providers for medical services provided to
the employees.
(4) Employer-sponsored health benefit plans are regulated
under the Employee Retirement Income Security Act of 1974,
however, States regulate the availability and the coverage
terms of stop-loss insurance coverage that employers purchase
to protect company assets and to protect a fund against excess
or unexpected claims losses.
(5) Both large and small employers that choose to self-fund
must also be able to protect company assets or a fund against
excess or unexpected claims losses and States must reasonably
regulate stop-loss insurance to assure its availability to both
large and small employers.
SEC. 2023. CERTAIN MEDICAL STOP-LOSS INSURANCE OBTAINED BY CERTAIN PLAN
SPONSORS OF GROUP HEALTH PLANS NOT INCLUDED UNDER THE
DEFINITION OF HEALTH INSURANCE COVERAGE.
Section 733(b)(1) of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1191b(b)(1)) is amended by adding at the end the
following sentence: ``Such term shall not include a stop-loss policy
obtained by a self-insured group health plan or a plan sponsor of a
group health plan that self-insures the health risks of its plan
participants to reimburse the plan or sponsor for losses that the plan
or sponsor incurs in providing health or medical benefits to such plan
participants in excess of a predetermined level set forth in the stop-
loss policy obtained by such plan or sponsor.''.
SEC. 2024. EFFECT ON OTHER LAWS.
Section 514(b) of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1144(b)) is amended by adding at the end the following:
``(10) The provisions of this title (including part 7
relating to group health plans) shall preempt State laws
insofar as they may now or hereafter prevent an employee
benefit plan that is a group health plan from insuring against
the risk of excess or unexpected health plan claims losses.''.
Subtitle D--Small Business Flexibility Act
SEC. 2031. SHORT TITLE.
This Act may be cited as the ``Small Business Flexibility Act''.
SEC. 2032. NOTIFICATION OF FLEXIBLE HEALTH INSURANCE BENEFITS.
(a) In General.--Subchapter C of chapter 100 of the Internal
Revenue Code of 1986 is amended by adding at the end the following new
section:
``SEC. 9835. NOTIFICATION OF FLEXIBLE HEALTH INSURANCE BENEFITS.
``(a) In General.--Not later than 1 year after the date of
enactment of this section, the Secretary shall notify employers of the
availability of tax-advantaged flexible health insurance benefits, with
an initial focus on small businesses, particularly in rural areas (as
defined in section 1393(a)(2)).
``(b) Definitions.--In this section:
``(1) Employer.--The term `employer' has the meaning given
such term in section 3(5) of the Employee Retirement Income
Security Act (29 U.S.C. 1002(5)).
``(2) Flexible health insurance benefits.--The term
`flexible health insurance benefits' means--
``(A) an individual contribution health
reimbursement arrangement (as described in the rule
entitled `Health Reimbursement Arrangements and Other
Account-Based Group Health Plans' (84 Fed. Reg. 28888
(June 20, 2019)));
``(B) a qualified small employer health
reimbursement arrangement (as defined in section
9831(d)(2)); and
``(C) the small employer health insurance credit
determined under section 45R.''.
(b) Clerical Amendment.--The table of sections for subchapter C of
chapter 100 of such Code is amended by adding at the end the following
new item:
``Sec. 9835. Notification of flexible health insurance benefits''.
Subtitle E--Health Coverage Choice Act
SEC. 2041. SHORT TITLE.
This Act may be cited as the ``Health Coverage Choice Act''.
SEC. 2042. DEFINITION OF SHORT-TERM LIMITED DURATION INSURANCE.
Section 2791(b) of the Public Health Service Act (42 U.S.C. 300gg-
91(b)) is amended by adding at the end the following new paragraph:
``(6) Short-term limited duration insurance.--The term
`short-term limited duration insurance' means health insurance
coverage provided under a contract with a health insurance
issuer that--
``(A) has an expiration date specified in the
contract that is less than 12 months after the original
effective date of the contract; and
``(B) has a duration of not more than 10 years
(taking into account renewals or extensions) after the
original effective date of the contract.''.
Subtitle F--IMPACT Act of 2025
SEC. 2051. SHORT TITLE.
This Act may be cited as the ``Improved Medical Patients Affordable
Care Today Act of 2025'' or the ``IMPACT Act of 2025.''
SEC. 2052. EXPANDING ELIGIBILITY FOR CATASTROPHIC PLANS.
(a) In General.--Section 1302(e)(2) of the Patient Protection and
Affordable Care Act (42. U.S.C. 18022(e)(2) is amended--
(1) in subparagraph (B)(ii), by striking the period at the
end and inserting ``; or''; and
(2) by adding at the end the following new subparagraph:
``(C) with respect to the plan year involved, is
determined to be ineligible (or reasonably expects to
be ineligible) for the premium tax credit under section
36B of the Internal Revenue Code of 1986 or for reduced
cost-sharing under section 1402 on the basis of the
individual's household income for such year.''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2026.
Subtitle G--New Health Options Act
SEC. 2061. SHORT TITLE.
This Act may be cited as the ``New Health Options Act''.
SEC. 2062. CREATION OF A REINSURANCE PROGRAM FOR A NEW HEALTH INSURANCE
RISK POOL.
(a) In General.--Part V of subtitle B of title I of the Patient
Protection and Affordable Care Act (42 U.S.C. 18061 et seq.) is amended
by adding at the end the following new section:
``SEC. 1344. REINSURANCE PROGRAM FOR CERTAIN OFF-EXCHANGE PLANS.
``(a) In General.--There is established a Reinsurance Program, to
be administered by the Secretary of Health and Human Services, to
provide payments to health insurance issuers with respect to claims for
eligible individuals for the purpose of lowering premiums for such
individuals.
``(b) Funding.--
``(1) Appropriation.--For the purpose of providing funding
for the Reinsurance Program, for each year during the period
beginning on January 1, 2026, and ending on December 31, 2030,
there is appropriated out of any monies in the Treasury not
otherwise obligated an amount equal to the product of $50 and
the aggregate number of member months for all eligible
individuals enrolled in a covered plan during such year.
``(2) Limitation on appropriation.--In no year shall the
appropriation for the Reinsurance Program authorized in
paragraph (1) exceed $6,000,000,000.
``(3) Use of unexpended funds.--Appropriated amounts
remaining unexpended at the end of any year may be used to make
payments under the Reinsurance Program in any future year.
``(4) Limitation on use of funds.--No funds received under
the Reinsurance Program may be used to pay for services
described in section 1303(b)(1)(B)(i) (as in effect on the date
of the enactment of this section).
``(c) Operation of Program.--
``(1) In general.--The Secretary shall establish parameters
for the operation of the Reinsurance Program consistent with
this section.
``(2) Deadline for initial operation.--Not later than 120
days after the date of the enactment, the Secretary shall
establish sufficient parameters to specify how the Program will
operate for 2026.
``(3) Definitions.--In this section:
``(A) Covered plan.--The term `covered plan' means
individual health insurance coverage (as such term is
defined in section 2791 of the Public Health Service
Act)--
``(i) with respect to which the issuer of
such coverage has made the election described
in section 1312(c)(1)(A); and
``(ii) that does not provide coverage for
services described in section 1303(b)(1)(B)(i)
(as in effect on the date of the enactment of
this section).
``(B) Eligible individual.--The term `eligible
individual' means an individual enrolled in a covered
plan.
``(d) Attachment Dollar Amount and Payment Proportion.--
``(1) In general.--The Secretary shall annually establish
an attachment point, payment proportion, and reinsurance cap
with respect to claims for eligible individuals for payments
under the Reinsurance Program, consistent with the following:
``(A) The attachment point for the period beginning
January 1, 2026, and ending December 31, 2026, shall be
$110,000.
``(B) The payment proportion for the period
beginning January 1, 2026, and ending December 31,
2026, shall be 90 percent.
``(C) The reinsurance cap for the period beginning
January 1, 2026 and ending December 31, 2026, shall be
$300,000.
``(2) Adjustment authority.--The Secretary may adjust any
amounts described in paragraph (1) as necessary to ensure the
Reinsurance Program does not make payment for a year in excess
of the amount available for such year under subsection (b).''.
(b) Election To Opt Out of Single Risk Pool.--
(1) In general.--Section 1312(c)(1) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18032(c)(1)) is
amended--
(A) by striking ``A health insurance issuer'' and
inserting the following:
``(A) In general.--A health insurance issuer'';
(B) in subparagraph (A), as inserted by paragraph
(1), by inserting ``and other than any health plan with
respect to which such issuer has elected for this
subparagraph not to apply'' after ``grandfathered
health plans''; and
(C) by adding at the end the following new
subparagraph:
``(B) Treatment of plans opting out of single risk
pool.--A health insurance issuer shall consider all
enrollees in all health plans offered by such issuer in
the individual market with respect to which such issuer
has made the election described in subparagraph (A) to
be members of a single risk pool.''.
(2) Prohibiting single risk pool opt out for qualified
health plans.--Section 1301(a)(1)(C) of the Patient Protection
and Affordable Care Act (42 U.S.C. 18021(a)(1)) is amended--
(A) in clause (iii), by striking ``and'' at the
end;
(B) in clause (iv), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(v) has not made the election described in section 1312(c)(1)(A)
with respect to such plan.''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to plan years beginning on or after
January 1, 2026.
(c) Removing Age Premium Variation Limitation for Certain Plans.--
(1) In general.--
(A) Removal of limitation for certain plans.--
Section 2701(a)(1)(A)(iii) of the Public Health Service
Act (42 U.S.C 300gg(a)(1)(A)(iii)) is amended by
inserting ``or, in the case of such coverage with
respect to which the issuer of such coverage has made
the election described in section 1312(c)(1)(A) of the
Patient Protection and Affordable Care Act, by more
than an actuarially justified amount for adults''
before ``; and''.
(B) Effective date.--The amendment made by
subparagraph (A) shall apply with respect to plan years
beginning on or after January 1, 2026.
(2) Maintaining age premium variation limitation for
qualified health plans.--Section 1301(a)(1) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18021(a)(1)), as
amended by subsection (b), is further amended--
(A) in subparagraph (B), by striking ``and'' at the
end;
(B) in subparagraph (C)(v), by striking the period
and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(D) with respect to the premium rate charged by
such plan, if such plan varies such rate by age, does
not vary such rate by more than 3 to 1 for adults
(consistent with section 2707(c) of the Public Health
Service Act).''.
(d) Treatment of Opt Out Plans in Relation to Individual Health
Coverage Reimbursement Arrangements.--The Secretaries of Health and
Human Services, Labor, and the Treasury shall not fail to treat any
individual health insurance coverage (as defined in section 2791 of the
Public Health Service Act (42 U.S.C. 300gg-91)) as eligible for
integration with an individual health care reimbursement arrangement on
the basis that the health insurance issuer (as so defined) of such
coverage has made the election described in section 1312(c)(1)(A) of
the Patient Protection and Affordable Care Act (as inserted by
subsection (b)).
SEC. 2062. PROMOTION OF HIGH-VALUE CARE.
(a) In General.--Subpart II of part A of title XXVII of the Public
Health Service Act (42 U.S.C. 300gg-11 et seq.) is amended by adding at
the end the following new section:
``SEC. 2730. APPLICATION OF CERTAIN OUT-OF-NETWORK COSTS TO DEDUCTIBLES
AND OUT-OF-POCKET MAXIMUMS.
``(a) In General.--A group health plan, and a health insurance
issuer offering group or individual health insurance coverage, shall,
in the case that an individual enrolled under such plan or coverage is
furnished items or services by a health care provider or health care
facility that does not have in effect a contractual relationship with
such plan or issuer for the furnishing of such items or services and
such individual incurs any out-of-pockets costs with respect to such
items and services, at the option of such individual, apply such costs
to any deductible or out-of-pocket maximum applicable to items and
services furnished by health care providers or health care facilities
with contracts in effect with such plan or issuer for the furnishing of
such items or services, but only if the following requirements are met:
``(1) The item or service furnished by such provider or
facility without a contract in effect with such plan or issuer
is an item or service for which benefits are available under
such plan or coverage.
``(2) The amount charged by such provider or facility for
such item or service is equal to or less than--
``(A) the lowest amount recognized by the plan or
coverage as payment for such item or service out of all
health care providers and health care facilities with a
contract in effect with such plan or issuer to furnish
such item or service in the same rating area (as
defined for purposes of section 2701) in which the item
or service described in paragraph (1) was furnished; or
``(B) the 25th percentile of charges for such item
or service furnished in the same State in which the
item or service described in paragraph (1) was
furnished.
``(b) Disclosure of Information.--A group health plan, and a health
insurance issuer offering group or individual health insurance
coverage, shall, with respect to each item or service for which
benefits are available under such plan or coverage, make available the
lowest amount described in subsection (a)(2)(A) and the 25th percentile
described in subsection (a)(2)(B) to all individuals enrolled under
such plan or coverage.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to plan years beginning on or after January 1, 2026.
SEC. 2064. DISCLOSURE OF LOWER PRICES.
Part E of title XXVII of the Public Health Service Act (42 U.S.C.
300gg-131) is amended by adding at the end the following new section:
``SEC. 2799B-10. DISCLOSURE OF LOWER PRICES.
``(a) In General.--Beginning January 1, 2026, each health care
provider and health care facility shall disclose to patients and
prospective patients enrolled in a group health plan, group or
individual health insurance coverage, or a Federal health care program
(as defined in section 1128B but including the program established
under chapter 89 of title 5, United States Code) being furnished or
seeking to be furnished an item or service by such provider or facility
for which benefits are available under such plan, coverage, or program,
as applicable, whether the amount of cost sharing (including
deductibles, copayments, and coinsurance) that would be incurred by
such individual for such item or service under such plan, coverage, or
program, as applicable, exceeds the charge that would apply for such
item or service for an individual without benefits under any such plan,
coverage, or program for such item or service.
``(b) Additional Enforcement.--In addition to any other penalty
applicable with respect to a violation of subsection (a), an individual
who is harmed by a violation of this section by a health care provider
or health care facility may bring an action against such provider or
facility in an appropriate district court of the United States for--
``(1) appropriate injunctive relief; and
``(2) damages in an amount that is equal to the amount
provided for such harm in a civil action under the law of the
State in which the provider or facility is located.''.
Subtitle H--Fighting Waste Fraud and Abuse in the Unaffordable Care Act
SEC. 2071. SHORT TITLE.
This Act may be cited as the ``Fighting Waste Fraud and Abuse in
the Unaffordable Care Exchanges Act of 2025''.
SEC. 2072. ADDRESSING WASTE, FRAUD, AND ABUSE IN THE ACA EXCHANGES.
(a) Changes to Enrollment Periods for Enrolling in Exchanges.--
Section 1311 of the Patient Protection and Affordable Care Act (42
U.S.C. 18031) is amended--
(1) in subsection (c)(6)--
(A) by striking subparagraph (A);
(B) by striking ``The Secretary'' and inserting the
following:
``(A) In general.--The Secretary'';
(C) by redesignating subparagraphs (B) through (D)
as clauses (i) through (iii) respectively, and
adjusting the margins accordingly;
(D) in clause (i), as so redesignated, by striking
``periods, as determined by the Secretary for calendar
years after the initial enrollment period;'' and
inserting the following: ``periods for plans offered in
the individual market--
``(I) for enrollment for plan years
beginning before January 1, 2027, as
determined by the Secretary; and
``(II) for enrollment for plan
years beginning on or after January 1,
2027, beginning on November 1, and
ending on December 15 of the preceding
calendar year;''.
(E) in clause (ii), as so redesignated, by
inserting ``subject to subparagraph (B),'' before
``special enrollment period specified''; and
(F) by adding at the end the following new
subparagraph;
``(B) Prohibited special enrollment period.--With
respect to plans years beginning on or after January 1,
2027, the Secretary may not require an Exchange to
provide for a special enrollment period for an
individual on the basis of the relationship of the
income of such individual to the poverty line, other
than a special enrollment period based on a change in
circumstances or the occurrence of a specific event.'';
(2) in subsection (d), by adding at the end the following
new paragraphs:
``(8) Prohibited enrollment periods.--An exchange may not
provide for, with respect to enrollment for plan years
beginning on or after January 1, 2027--
``(A) an annual open enrollment period other than
the period described in subparagraph (A)(i) of
subsection (c)(6); or
``(B) a special enrollment period described in
subparagraph (B) of such subsection.
``(9) Verification of eligibility for special enrollment
periods.--
``(A) In general.--With respect to enrollment for
plan years beginning on or after January 1, 2027, an
Exchange shall verify that each individual seeking to
enroll in a qualified health plan offered by the
Exchange during a special enrollment period selected
under paragraph (B) is eligible to enroll during such
special enrollment period prior to enrolling such
individual in such plan.
``(B) Selected special enrollment periods.--For
purposes of subparagraph (A), an Exchange shall select
one or more special enrollment periods for a plan year
with respect to which such Exchange shall conduct the
verification required under subparagraph (A) such that
the Exchange conducts such verification for not less
than 75 percent of all individuals enrolling in a
qualified health plan offered by the Exchange during
any special enrollment period with respect to such plan
year.''.
(b) Verifying Income for Individuals Enrolled in a Qualified Health
Plan Through an Exchange.--
(1) In general.--Section 1411(e)(4) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18081(e)(4)) is
amended--
(A) by redesignating subparagraph (C) as
subparagraph (E); and
(B) by inserting after subparagraph (B) the
following new subparagraphs:
``(C) Requiring verification of income and family
size when tax data is unavailable.--For plan years
beginning on or after January 1, 2027, for purposes of
subparagraph (A), in the case that the Exchange
requests data from the Secretary of the Treasury
regarding an individual's household income and the
Secretary of the Treasury does not return such data,
such information may not be verified solely on the
basis of the attestation of such individual with
respect to such household income, and the Exchange
shall take the actions described in subparagraph (A).
``(D) Requiring verification of income in the case
of certain income discrepancies.--
``(i) In general.--Subject to clause (iii),
for plan years beginning on or after January 1,
2027, for purposes of subparagraph (A), in the
case that a specified income discrepancy
described in clause (ii) of this subparagraph
exists with respect to the information provided
by an applicant under subsection (b)(3), the
household income of such individual shall be
treated as inconsistent with information in the
records maintained by persons under subsection
(c), or as not verified under subsection (d),
and the Exchange shall take the actions
described in such subparagraph (A).
``(ii) Specified income discrepancy.--For
purposes of clause (i), a specified income
discrepancy exists with respect to the
information provided by an applicant under
subsection (b)(3) if--
``(I) the applicant attests to a
projected annual household income that
would qualify such applicant to be an
applicable taxpayer under section
36B(c)(1)(A) of the Internal Revenue
Code of 1986 with respect to the
taxable year involved;
``(II) the Exchange receives data
from the Secretary of the Treasury or
other reliable, third party data, that
indicates that the household income of
such applicant is less than the
household income that would qualify
such applicant to be an applicable
taxpayer under such section
36B(c)(1)(A) with respect to the
taxable year involved;
``(III) such attested projected
annual household income exceeds the
income reflected in the data described
in subclause (II) by a reasonable
threshold established by the Exchange
and approved by the Secretary (which
shall be not less than 10 percent, and
may also be a dollar amount); and
``(IV) the Exchange has not
assessed or determined based on the
data described in subclause (II) that
the household income of the applicant
meets the applicable income-based
eligibility standard for the Medicaid
program under title XIX of the Social
Security Act or the State children's
health insurance program under title
XXI of such Act.
``(iii) Exclusion of certain individuals
ineligible for medicaid.--The subparagraph
shall not apply in the case of an applicant who
is an alien lawfully present in the United
States, who is not eligible for the Medicaid
program under title XIX of the Social Security
Act by reason of such alien status.''.
(2) Requiring individuals on whose behalf advance payments
of the premium tax credit are made to file and reconcile on an
annual basis.--Section 1412(b) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18082(b)) is amended by adding
at the end the following new paragraph:
``(3) Annual requirement to file and reconcile.--
``(A) In general.--For plan years beginning on or
after January 1, 2027, in the case of an individual
with respect to whom any advance payment of the premium
tax credit allowable under section 36B of the Internal
Revenue Code of 1986 was made under this section to the
issuers of a qualified health plan for the relevant
prior tax year, an advance determination of eligibility
for such premium tax credit may not be made under this
subsection with respect to such individual and such
plan year if the Exchange determines, based on
information provided by the Secretary of the Treasury,
that such individual--
``(i) has not filed an income tax return,
as required under section 6011 and 6012 of such
code (and implementing regulations), for the
relevant prior tax year; or
``(ii) as necessarily, has not been
reconciled (in accordance with subsection (f)
of such section 36B) the advance payment of the
premium tax credit made with respect to such
individual for such relevant prior tax year.
``(B) Relevant prior tax year.--For purposes of
subparagraph (A), the term `relevant prior tax year'
means, with respect to the advance determination of
eligibility made under this subsection with respect to
an individual, the taxable year for which tax return
data would be used for purposes of verifying the
household income and family size of such individual (as
described in section 1411(b)(3)(A)).
``(C) Preliminary attestation.--If an individual
subject to subparagraph (A) attests that such
individual has fulfilled the requirements to file an
income tax return for the relevant prior tax year and,
as necessary, to reconcile the advance payment of the
premium tax credit made with respect to such individual
for such relevant prior tax year (as described in
clauses (i) and (ii) of such subparagraph), the
Secretary may make an initial advance determination of
eligibility with respect to such individual and may
delay for a reasonable period (as determined by the
Secretary) any determination based on information
provided by the Secretary of the Treasury that such
individual has not fulfilled such requirements.
``(D) Notice.--If the Secretary determines that an
individual did not meet the requirements described in
subparagraph (A) with respect to the relevant prior tax
year and notifies the Exchange of such determination,
the Exchange shall comply with the notification
requirement described in section 155.305(f)(4)(i) of
title 45, Code of Federal Regulations (as in effect
with respect to plan year 2025).''.
(3) Removing automatic extension of period to resolve
income inconsistencies.--The Secretary of Health and Human
Services shall revise section 155.315(f) of title 45, Code of
Federal Regulations, to remove paragraph (7) of such section,
such that, with respect to enrollment for plan years beginning
on or after January 1, 2027, in the case that an Exchange
established under subtitle D of title I of the Patient
Protection and Affordable Care Act (42 U.S.C. 18021 et seq.)
provides an individual applying for enrollment in a qualified
health plan with a 90-day period to resolve an inconsistency in
the application of such individual pursuant to section
1411(e)(4)(A)(ii)(II) of such Act, the Exchange may not provide
for an automatic extension to such 90-day period on the basis
that such individual is required to present satisfactory
documentary evidence to verify household income.
(c) Revising Rules of Allowable Variation in Actuarial Value of
Health Plans.--The Secretary of Health and Human Services shall--
(1) revise section 156.140(c) of title 45, Code of Federal
Regulations, to provide that, for plan years beginning on or
after January 1, 2027, the allowable variation in the actuarial
value of a health plan applicable under such section shall be
the allowable variation for such plan applicable under such
section for plan year 2022;
(2) revise sections 156.29(b)(3) of title 45, Code of
Federal Regulations, to provide that, for plan years beginning
on or after January 1, 2027, the requirement for a qualified
health plan issuer described in such section is that the issuer
ensures that each qualified health plan complies with benefit
design standards, as defined in section 156.20 of such title;
and
(3) revise section 156.400 of title 45, Code of Federal
Regulations, to provide that, for plans years beginning on or
after January 1, 2027, the term ``de minimum variation for a
silver plan variation'' means a minus 1 percentage point and
plus 1 percentage point allowable actuarial value variation.
(d) Updating Premium Adjustment Percentage Methodology.--Section
1302(c)(4) of the Patient Protection and Affordable Care Act (42 U.S.C.
18022(c)(4)) is amended--
(1) by striking ``For purposes'' and inserting:
``(A) In general.--For purposes''; and
(2) by adding at the end the following new subparagraph:
``(B) Update to methodology.--For calendar years
beginning with 2027, the premium adjustment percentage
under this paragraph for such calendar year shall be
determined consistent with the methodology published in
the Federal Register on April 25, 2019 (84 Fed. Reg.
17537 through 17541).''.
(e) Eliminating the Fixed-Dollar and Gross-Percentage Thresholds
Applicable to Exchange Enrollments.--The Secretary of Health and Human
Services shall revise section 155.400(g) of title 45, Code of Federal
Regulations to eliminate, for plan years beginning on or after January
1, 2027, the gross premium percentage-base premium payment threshold
policy described in paragraph (2) of such section and the fixed-dollar
premium payment threshold policy described in paragraph (3) of such
section.
(f) Prohibiting Automatic Reenrollment From Bronze to Silver Level
Qualified Health Plans Offered by Exchanges.--The Secretary of Health
and Human Services shall revise section 155.335(j) of title 45, Code of
Federal Regulations, to remove paragraph (4) of such section that, with
respect to reenrollments for plan years beginning on or after January
1, 2027, an Exchange established under subtitle D of title I of the
Patient Protection and Affordable Care Act (42 U.S.C. 18021 et seq.)
may not reenroll an individual who was enrolled in a bronze level
qualified health plan in a silver level qualified health plan (as such
terms are defined in section 1301(a) and described in 1302(d) of such
Act) unless otherwise permitted under section 155.335(j) of title 45,
Code of Federal Regulations, as in effect on the day before the date of
the enactment of this section.
(g) Reducing Advance Payments of Premium Tax Credits for Certain
Individuals Reenrolled in Exchanges.--Section 1412 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18082) is amended--
(1) in subsection (a)(3), by inserting ``, subject to
subsection (c)(2)(C),'' after ``qualified health plans''; and
(2) in subsection (c)(2)--
(A) in subparagraph (A), by striking ``The'' and
inserting ``Subject to subparagraph (C), the''; and
(B) by adding at the end the following
subparagraph:
``(C) Reduction in advance payment for specified
reenrolled individuals.--
``(i) In general.--The amount of an advance
payment made under subparagraph (A) to reduce
the premium payable for a qualified health plan
that provides coverage to a specific reenrolled
individual for an applicable month shall be an
amount equal to the amount that would otherwise
be made under such subparagraph reduced by $5
(or such higher amount as the Secretary
determines appropriate).
``(ii) Definitions.--In this subparagraph:
``(I) Applicable month.--The term
`applicable month' means, with respect
to a specified reenrolled individual,
any month during a plan year beginning
on or after January 1, 2027 (or, in the
case of an individual reenrolled in a
qualified health plan by an Exchange
established pursuant to section
1321(c), January 1, 2027) if, prior to
the first day of such month, such
individual has failed to confirm or
update such information as is necessary
to redetermine the eligibility of such
individual for such plan year pursuant
to section 1411(f).
``(II) Specified reenrolled
individual.--The term `specified
reenrolled individual' means an
individual who is reenrolled in a
qualified health plan and with respect
to whom the advance payment made under
subparagraph (A) would, without
application of any reduction under this
subparagraph, reduce the premium
payable for a qualified health plan
that provides coverage to such an
individual to $0.''.
(h) Prohibiting Coverage of Gender Transition Procedures as an
Essential Health Benefit Under Plans Offered by Exchanges.--
(1) In general.--Section 1302(b)(2) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18022(b)(2)) is
amended by adding at the end the following new subparagraph:
``(C) Gender transition procedures.--For plan years
beginning on or after January 1, 2027, the essential
health benefits defined pursuant to paragraph (1) may
not include items and services furnished for a gender
transition procedure.''.
(2) Gender transition procedure defined.--Section 1304 of
the Patient Protection and Affordable Care Act (42 U.S.C.
18024) is amended by adding at the end the following new
subsection:
``(f) Gender Transition Procedure.--
``(1) In general.--In this title, except as provided in
paragraph (2), the term `gender transition procedure' means,
with respect to an individual, any of the following when
performed for this purpose of intentionally changing the body
of such individual (including by disrupting the body's
development, inhibiting its natural functions, or modifying its
appearance) to no longer correspond to the individuals sex:
``(A) Performing any surgery, including--
``(i) castration;
``(ii) sterilization;
``(iii) orchiectomy;
``(iv) scrotoplasty;
``(v) vasectomy;
``(vi) tubal ligation;
``(vii) hysterectomy;
``(viii) oophorectomy;
``(ix) ovariectomy;
``(x) metoidioplasty;
``(xi) clitoroplasty;
``(xii) reconstruction of the fixed part of
the urethra with or without a metoidioplasty or
a phalloplasty;
``(xiii) penectomy;
``(xiv) phalloplasty;
``(xv) vaginoplasty;
``(xvi) vaginectomy;
``(xvii) vulvoplasty;
``(xviii) reduction thyrochondroplasty;
``(xix) chrondrolaryngoplasty;
``(xx) mastectomy; and
``(xxi) any plastic, cosmetic, or aesthetic
surgery that feminizes or masculinizes the
facial or other body features of an individual.
``(B) Any placement of chest implants to create
feminine breasts or any placement of erection or
testicular prostheses.
``(C) Any placement of fat or artificial implants
in the gluteal region.
``(D) Administering, prescribing, or dispensing to
an individual medications, including--
``(i) gonadotropin-releasing hormone (GnRH)
analogues or other puberty-blocking drugs to
stop or delay normal puberty; and
``(ii) testosterone, estrogen, or other
androgens to an individual at doses that are
superphysiologic than would normally be
produced endogenously in a health individual of
the same age and sex.
``(2) Exception.--Paragraph (1) shall not apply to the
following:
``(A) Puberty suppression or blocking prescription
drugs for the purpose of normalizing puberty for an
individual experiencing precocious puberty.
``(B) Medically necessary procedures or treatments
to correct for--
``(i) a medically verifiable disorder of
sex development, including--
``(I) 46, XX chromosomes with
virilization;
``(II) 46, XY chromosomes with
undervirilization; and
``(III) both ovarian and testicular
tissue;
``(ii) sex chromosome structure, sex
steroid hormone production, or sex hormone
action, if determined to be abnormal by a
physician through genetic or biochemical
testing;
``(iii) infection, disease, injury, or
disorder caused or exacerbated by a previous
procedure described in paragraph (1), or a
physical disorder, physical injury, or physical
illness that would, as certified by a
physician, place the individual in imminent
danger of death or impairment of a major bodily
function unless the procedure is performed, not
including procedures performed for the
alleviation of mental distress; or
``(iv) procedures to restore or reconstruct
the body of the individual in order to
correspond to the individual's sex after one or
more previous procedures described in paragraph
(1), which may include the removal of a pseudo
phallus or breast augmentation.
``(3) Sex.--For purposes of this subsection, the term `sex'
means either male or female, as biologically determined and
defined by subparagraph (A) and subparagraph (B).
``(A) Female.--The term `female' means an
individual who naturally has, had, will have, or would
have, but for a developmental or genetic anomaly or
historical accident, the reproductive systems that at
some point produces, transports, and utilizes eggs for
fertilization.
``(B) Male.--The term `male' means an individual
who naturally has, had, will have, or would have, but
for a developmental or genetic anomaly or historical
accident, the reproductive system that at some point
produces, transports, and utilizes sperm for
fertilization.''.
(i) Ensuring Appropriate Application of Guaranteed Issue
Requirements in Case of Non-Payment of Past Premiums.--
(1) In general.--Section 2702 of the Public Health Service
Act (42 U.S.C. 300gg-1) is amended by adding at the end the
following new subsection:
``(e) Nonpayment of Past Premiums.--
``(1) In general.--A health insurance issuer offering
individual health coverage may, to the extent allowed under
State law, deny such coverage in the case of an individual who
owes any amount for premiums for individual health insurance
coverage offered by such issuer (or by a health insurance
issuer in the same controlled group (as defined in paragraph
(3)) as such issuer) in which such individual was previously
enrolled.
``(2) Attribution of initial premium payment owed amount.--
A health insurance issued offering individual health insurance
coverage may, in the case of an individual described in
paragraph (1) and to the extent allowed under State law,
attribute the initial premium payment for such coverage
applicable to such individual to the amount owed by such
individual for premiums for individual health insurance
coverage offered by such issuer (or by a health insurance
issuer in the same controlled group as the issuer) in which
such individual was previously enrolled.
``(3) Controlled group defined.--For purposes of this
subsection, the term `controlled group' means a group of two or
more persons that is treated as a single employed under section
52(a), 52(b), 414(m), or 414(o) of the Internal Revenue Code of
1986.''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply with respect to plan years beginning on or after
January 1, 2027.
SEC. 2073. FUNDING COST-SHARING REDUCTION PAYMENTS.
Section 1402 of the Patient Protection and Affordable Care Act (42
U.S.C. 18071) is amended by adding at the end the following new
subsection:
``(h) Funding.--
``(1) In general.--There are appropriated out of any monies
in the Treasury not otherwise appropriated such sums as may be
necessary for purposes of making payments under this section
for plan years beginning on or after January 1, 2027.
``(2) Limitation.--
``(A) In general.--The amounts appropriated under
paragraph (1) may not be used for purposes of making
payments under this section for a qualified health plan
that provides health benefit coverage that includes
coverage of abortion.
``(B) Exception.--Subparagraph (A) shall not apply
to payments for a qualified health plan that provides
coverage of abortion only if necessary to save the life
of the mother or if the pregnancy is a result of an act
of rape or incest.''.
TITLE III--ENDING TAXPAYER FUNDING FOR ABORTION AND GENDER TRANSITION
PROCEDURES
Subtitle A--No Taxpayer Funding for Abortion and Abortion Insurance
Full Disclosure Act of 2025
SEC. 3000. APPLICABILITY TO ENTIRE ACT.
(a) Notwithstanding any other provision of law, the prohibitions
and limitations set forth in this title, including the amendments made
by this title, shall apply to all funds authorized or appropriated
under this Act, including under title I, title II, and every subtitle
thereof, and to any trust fund to which such funds are contributed.
(b) Effective Date.--This section shall take effect on the date of
the enactment of this Act.
SEC. 3001. SHORT TITLE.
This Act may be cited as the ``No Taxpayer Funding for Abortion and
Abortion Insurance Full Disclosure Act of 2025''.
SEC. 3002. PROHIBITING TAXPAYER FUNDED ABORTIONS.
Title 1, United States Code, is amended by adding at the end the
following new chapter:
``CHAPTER 4--PROHIBITING TAXPAYER FUNDED ABORTIONS
``Sec. 301. Prohibition on funding for abortions
``No funds authorized or appropriated by Federal law, and none of
the funds in any trust fund to which funds are authorized or
appropriated by Federal law, shall be expended for any abortion.
``Sec. 302. Prohibition on funding for health benefits plans that cover
abortion
``None of the funds authorized or appropriated by Federal law, and
none of the funds in any trust fund to which funds are authorized or
appropriated by Federal law, shall be expended for health benefits
coverage that includes coverage of abortion.
``Sec. 303. Limitation on federal facilities and employees
``No health care service furnished--
``(1) by or in a health care facility owned or operated by
the Federal Government; or
``(2) by any physician or other individual employed by the
Federal Government to provide health care services within the
scope of the physician's or individual's employment, may
include abortion.
``Sec. 304. Construction relating to separate coverage
``Nothing in this chapter shall be construed as prohibiting any
individual, entity, or State or locality from purchasing separate
abortion coverage or health benefits coverage that includes abortion so
long as such coverage is paid for entirely using only funds not
authorized or appropriated by Federal law and such coverage shall not
be purchased using matching funds required for a federally subsidized
program, including a State's or locality's contribution of Medicaid
matching funds.
``Sec. 305. Construction relating to the use of non-federal funds for
health coverage
``Nothing in this chapter shall be construed as restricting the
ability of any non-Federal health benefits coverage provider from
offering abortion coverage, or the ability of a State or locality to
contract separately with such a provider for such coverage, so long as
only funds not authorized or appropriated by Federal law are used and
such coverage shall not be purchased using matching funds required for
a federally subsidized program, including a State's or locality's
contribution of Medicaid matching funds.
``Sec. 306. Non-preemption of other federal laws
``Nothing in this chapter shall repeal, amend, or have any effect
on any other Federal law to the extent such law imposes any limitation
on the use of funds for abortion or for health benefits coverage that
includes coverage of abortion, beyond the limitations set forth in this
chapter.
``Sec. 307. Construction relating to complications arising from
abortion
``Nothing in this chapter shall be construed to apply to the
treatment of any infection, injury, disease, or disorder that has been
caused by or exacerbated by the performance of an abortion. This rule
of construction shall be applicable without regard to whether the
abortion was performed in accord with Federal or State law, and without
regard to whether funding for the abortion is permissible under section
308.
``Sec. 308. Treatment of abortions related to rape, incest, or
preserving the life of the mother
``The limitations established in sections 301, 302, and 303 shall
not apply to an abortion--
``(1) if the pregnancy is the result of an act of rape or
incest; or
``(2) in the case where a woman suffers from a physical
disorder, physical injury, or physical illness that would, as
certified by a physician, place the woman in danger of death
unless an abortion is performed, including a life-endangering
physical condition caused by or arising from the pregnancy
itself.
``Sec. 309. Application to district of columbia
``In this chapter:
``(1) Any reference to funds appropriated by Federal law
shall be treated as including any amounts within the budget of
the District of Columbia that have been approved by an Act of
Congress pursuant to section 446 of the District of Columbia
Home Rule Act (or any applicable successor Federal law).
``(2) The term `Federal Government' includes the Government
of the District of Columbia.''.
SEC. 3003. AMENDMENT TO TABLE OF CHAPTERS.
The table of chapters for title 1, United States Code, is amended
by adding at the end the following new item:
``4 Prohibiting taxpayer funded abortions................... 301''.
SEC. 3004. CLARIFYING APPLICATION OF PROHIBITION TO PREMIUM CREDITS AND
COST-SHARING REDUCTIONS UNDER ACA.
(a) In General.--
(1) Disallowance of refundable credit and cost-sharing
reductions for coverage under qualified health plan which
provides coverage for abortion.--
(A) In general.--Subparagraph (A) of section
36B(c)(3) of the Internal Revenue Code of 1986 is
amended by inserting before the period at the end the
following: ``or any health plan that includes coverage
for abortions (other than any abortion or treatment
described in section 307 or 308 of title 1, United
States Code)''.
(B) Option to purchase or offer separate coverage
or plan.--Paragraph (3) of section 36B(c) of such Code
is amended by adding at the end the following new
subparagraph:
``(C) Separate abortion coverage or plan allowed.--
``(i) Option to purchase separate coverage
or plan.--Nothing in subparagraph (A) shall be
construed as prohibiting any individual from
purchasing separate coverage for abortions
described in such subparagraph, or a health
plan that includes such abortions, so long as
no credit is allowed under this section with
respect to the premiums for such coverage or
plan.
``(ii) Option to offer coverage or plan.--
Nothing in subparagraph (A) shall restrict any
non-Federal health insurance issuer offering a
health plan from offering separate coverage for
abortions described in such subparagraph, or a
plan that includes such abortions, so long as
premiums for such separate coverage or plan are
not paid for with any amount attributable to
the credit allowed under this section (or the
amount of any advance payment of the credit
under section 1412 of the Patient Protection
and Affordable Care Act).''.
(2) Disallowance of small employer health insurance expense
credit for plan which includes coverage for abortion.--
Subsection (h) of section 45R of the Internal Revenue Code of
1986 is amended--
(A) by striking ``Any term'' and inserting the
following:
``(1) In general.--Any term''; and
(B) by adding at the end the following new
paragraph:
``(2) Exclusion of health plans including coverage for
abortion.--
``(A) In general.--The term `qualified health plan'
does not include any health plan that includes coverage
for abortions (other than any abortion or treatment
described in section 307 or 308 of title 1, United
States Code).
``(B) Separate abortion coverage or plan allowed.--
``(i) Option to purchase separate coverage
or plan.--Nothing in subparagraph (A) shall be
construed as prohibiting any employer from
purchasing for its employees separate coverage
for abortions described in such subparagraph,
or a health plan that includes such abortions,
so long as no credit is allowed under this
section with respect to the employer
contributions for such coverage or plan.
``(ii) Option to offer coverage or plan.--
Nothing in subparagraph (A) shall restrict any
non-Federal health insurance issuer offering a
health plan from offering separate coverage for
abortions described in such subparagraph, or a
plan that includes such abortions, so long as
such separate coverage or plan is not paid for
with any employer contribution eligible for the
credit allowed under this section.''.
(3) Conforming aca amendments.--Section 1303(b) of Public
Law 111-148 (42 U.S.C. 18023(b)) is amended--
(A) by striking paragraph (2);
(B) by striking paragraph (3), as amended by
section 202(a); and
(C) by redesignating paragraph (4) as paragraph
(2).
(b) Application to Multi-State Plans.--Paragraph (6) of section
1334(a) of Public Law 111-148 (42 U.S.C. 18054(a)) is amended to read
as follows:
``(6) Coverage consistent with federal abortion policy.--In
entering into contracts under this subsection, the Director
shall ensure that no multi-State qualified health plan offered
in an Exchange provides health benefits coverage for which the
expenditure of Federal funds is prohibited under chapter 4 of
title 1, United States Code.''.
(c) Effective Date.--The amendments made by subsection (a) shall
apply to taxable years ending after December 31, 2025, but only with
respect to plan years beginning after such date, and the amendment made
by subsection (b) shall apply to plan years beginning after such date.
SEC. 3005. REVISION TO NOTICE REQUIREMENTS REGARDING DISCLOSURE OF
EXTENT OF HEALTH PLAN COVERAGE OF ABORTION AND ABORTION
PREMIUM SURCHARGES.
(a) In General.--Paragraph (3) of section 1303(b) of Public Law
111-148 (42 U.S.C. 18023(b)) is amended to read as follows:
``(3) Rules relating to notice.--
``(A) In general.--The extent of coverage (if any)
of services described in paragraph (1)(B)(i) or
(1)(B)(ii) by a qualified health plan shall be
disclosed to enrollees at the time of enrollment in the
plan and shall be prominently displayed in any
marketing or advertising materials, comparison tools,
or summary of benefits and coverage explanation made
available with respect to such plan by the issuer of
the plan, by an Exchange, or by the Secretary,
including information made available through an
internet portal or Exchange under sections 1311(c)(5)
and 1311(d)(4)(C).
``(B) Separate disclosure of abortion surcharges.--
In the case of a qualified health plan that includes
the services described in paragraph (1)(B)(i) and where
the premium for the plan is disclosed, including in any
marketing or advertising materials or any other
information referred to in subparagraph (A), the
surcharge described in paragraph (2)(B)(i)(II) that is
attributable to such services shall also be disclosed
and identified separately.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to materials, tools, or other information made available more
than 30 days after the date of the enactment of this Act.
Subtitle B--Prohibiting Federal Funding for Gender Transition
Procedures
SEC. 3006. SHORT TITLE.
This Act may be cited as the ``End Taxpayer Funding of Gender
Experimentation Act of 2025''
SEC. 3007. PROHIBITING FEDERAL FUNDING FOR GENDER TRANSITION
PROCEDURES.
(a) Definition.--In this section, the term ``Specified sex-trait
modification procedure'' means any pharmaceutical or surgical
intervention that is provided for the purpose of attempting to align an
individual's physical appearance or body with an asserted identity that
differs from the individual's sex either by:
(1) Intentionally disrupting or suppressing the normal
development of natural biological functions, including primary
or secondary sex-based traits; or
(2) Intentionally altering an individual's physical
appearance or body, including amputating, minimizing or
destroying primary or secondary sex-based traits such as the
sexual and reproductive organs.
(3) This term does not include procedures undertaken:
(A) To treat a person with a medically verifiable
disorder of sexual development; or
(B) For purposes other than attempting to align an
individual's physical appearance or body with an
asserted identity that differs from the individual's
sex.
(b) General Prohibition.--Notwithstanding any other provision of
law, no Federal funds (including funds provided through grants,
contracts, insurance, or any other means) may be used to pay for,
reimburse, or otherwise support any specified sex-trait modification
procedure.
(c) Effective Date.--The amendments made by this section shall take
effect on the date of the enactment of this Act and shall apply to
payments, reimbursements, and services provided on or after such date.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and the Judiciary, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and the Judiciary, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and the Judiciary, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and the Judiciary, 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.
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