I 
119TH CONGRESS 
1ST SESSION H. R. 3080 
To ensure health care fairness and affordability for all Americans through 
universal access to equitable health insurance tax credits, reformed health 
savings accounts, and strengthened consumer protections, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 29, 2025 
Mr. SESSIONS introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Ways and Means, and Education and Workforce, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To ensure health care fairness and affordability for all Amer-
icans through universal access to equitable health insur-
ance tax credits, reformed health savings accounts, and 
strengthened consumer protections, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; PURPOSES; TABLE OF CON-
TENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Health Care Fairness for All Act’’. 
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(b) PURPOSES.—The purposes of this Act are as fol-
lows: 
(1) ELIMINATION
OF
INDIVIDUAL
AND
EM-
PLOYER MANDATES.—To eliminate mandates on in-
dividuals and employers, and other tax requirements, 
imposed under Public Law 111–148. 
(2) PROVIDING
STATES
WITH
ALTERNATIVE, 
AFFORDABLE
COVERAGE
OPTIONS.—To 
provide 
greater flexibility in providing States with options in 
making affordable health insurance coverage avail-
able by eliminating certain mandates under Public 
Law 111–148, while retaining essential consumer 
protections, by promoting health savings accounts to 
pay for such coverage and long-term care coverage, 
while permitting States to continue coverage as pro-
vided under such public law. 
(c) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; purposes; table of contents. 
Sec. 2. Definitions. 
TITLE I—REVISION OF FEDERAL HEALTH LAW 
Subtitle A—Elimination of Employer and Individual Mandates 
Sec. 101. Repeal of individual health insurance mandate. 
Sec. 102. Repeal of employer health insurance mandate. 
Sec. 103. Clarifying employer’s ability to reimburse employee premiums for 
purchase of individual health insurance coverage. 
Subtitle B—Limitation on Application of Federal Health Plan Requirements 
Sec. 121. Limiting application of requirements to consumer protections. 
Sec. 122. Offering of basic health insurance; protection of assets from liability 
or attachment or seizure. 
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Sec. 123. Ensuring access to short-term limited duration insurance. 
Sec. 124. Making telehealth flexibilities permanent. 
Subtitle C—Health Insurance Tax Benefit 
Sec. 131. Health insurance tax benefit. 
Sec. 132. Application of portion of unused tax credits by States for indigent 
health care. 
Sec. 133. Medicaid option of enrollment under private plan and contribution to 
an HSA. 
Sec. 134. Repeal of reporting requirements relating to employee health insur-
ance premiums and health plan benefits. 
Sec. 135. Report. 
Subtitle D—Medicare Reforms 
Sec. 141. Physician-owned hospitals. 
Sec. 142. Prohibiting the use of an inpatient-only list in designating hospital 
outpatient services under the Medicare program. 
Sec. 143. Promoting Medicare site-neutral payments. 
Sec. 144. Medicare Advantage contributions to Roth HSAs for chronically ill 
enrollees. 
Sec. 145. Extending acute hospital care at home waiver flexibilities. 
TITLE II—IMPROVING HEALTH SAVINGS ACCOUNTS TO PROMOTE 
ACCOUNTABILITY 
Sec. 201. Transition to non-deductible HSAs. 
Sec. 202. Elimination of medical expense deduction. 
Sec. 203. Treatment of HSA after death of account beneficiary. 
Sec. 204. Treatment of direct patient care arrangements. 
TITLE III—STATE FLEXIBILITY IN REGULATION OF HEALTH 
INSURANCE COVERAGE 
Sec. 301. State flexibility in regulation of health insurance coverage. 
TITLE IV—MEDICAID PAYMENT REFORM 
Sec. 401. Medicaid payment reform to ensure equitable access to care. 
TITLE V—PRICE TRANSPARENCY 
Sec. 501. Promoting transparent hospital prices for consumers. 
SEC. 2. DEFINITIONS. 
Except as otherwise provided, in this Act: 
(1) BASIC
HEALTH
INSURANCE.—The term 
‘‘basic health insurance’’ is defined in section 
122(a). 
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(2) 
DEFAULT
HEALTH
INSURANCE
COV-
ERAGE.—The term ‘‘default health insurance cov-
erage’’ is defined in section 121(b)(4)(B). 
(3) EXCHANGE.—The term ‘‘Exchange’’ means 
an Exchange established under title I of Public Law 
111–148. 
(4) HEALTH
INSURANCE
COVERAGE; GROUP 
HEALTH PLAN, ETC.—The terms defined in section 
2791 of the Public Health Service Act, including 
‘‘health insurance coverage’’, ‘‘group health plan’’ 
‘‘individual market’’, shall apply. 
(5) LIMITED BENEFIT INSURANCE.—The term 
‘‘limited benefit insurance’’ is defined in section 
122(b). 
(6) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(7) STATE.—The term ‘‘State’’ includes the 
District of Columbia, Puerto Rico, the United States 
Virgin Islands, American Samoa, Guam, and the 
Northern Mariana Islands. 
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TITLE I—REVISION OF FEDERAL 
HEALTH LAW 
Subtitle A—Elimination of 
Employer and Individual Mandates 
SEC. 101. REPEAL OF INDIVIDUAL HEALTH INSURANCE 
MANDATE. 
Section 5000A of the Internal Revenue Code of 1986 
is amended by adding at the end the following new sub-
section: 
‘‘(h) TERMINATION.—This section shall not apply to 
months beginning after December 31, 2024.’’. 
SEC. 102. REPEAL OF EMPLOYER HEALTH INSURANCE MAN-
DATE. 
(a) IN GENERAL.—Chapter 43 of the Internal Rev-
enue Code of 1986 is amended— 
(1) by striking section 4980H, and 
(2) by striking the item relating to section 
4980H from the table of sections for such chapter. 
(b) REPEAL
OF RELATED REPORTING REQUIRE-
MENTS.—Subpart D of part III of subchapter A of chap-
ter 61 of such Code is amended by striking section 6056 
and by striking the item relating to section 6056 in the 
table of sections for such subpart. 
(c) CONFORMING AMENDMENTS.— 
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(1) Section 6724(d)(1)(B) of such Code is 
amended by striking clause (xxv). 
(2) Section 6724(d)(2) of such Code is amend-
ed by striking subparagraph (HH). 
(3) Section 1513 of Public Law 111–148 is 
amended by striking subsection (c). 
(d) EFFECTIVE DATES.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided in this subsection, the amendments made by 
this section shall apply to months and other periods 
beginning more than 30 days after the date of the 
enactment of this Act. 
(2) REPEAL
OF
STUDY
AND
REPORT.—The 
amendment made by subsection (c)(3) shall take ef-
fect on the date of the enactment of this Act. 
SEC. 103. CLARIFYING EMPLOYER’S ABILITY TO REIM-
BURSE 
EMPLOYEE 
PREMIUMS 
FOR 
PUR-
CHASE OF INDIVIDUAL HEALTH INSURANCE 
COVERAGE. 
An employer health care arrangement, such as a 
health or medical reimbursement arrangement (HRA) or 
other employment plans, under which an employer reim-
burses an employee for the premiums for the purchase of 
individual health insurance coverage does not constitute 
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a group health plan for any purposes, including for pur-
poses of applying any of the following: 
(1) The Public Health Service Act (including 
sections 2711 and 2714 of such Act, 42 U.S.C. 
300gg–11, 300gg–14). 
(2) Public Law 111–148. 
(3) The Internal Revenue Code of 1986 (other 
than for purposes of section 36B of such Code). 
(4) The Employee Retirement Income Security 
Act of 1974. 
(5) The HIPAA privacy regulations (as defined 
in section 1180(b)(3) of the Social Security Act, 42 
U.S.C. 1320d–9(b)(3)). 
(6) The Health Insurance Portability and Ac-
countability Act of 1996. 
(7) COBRA continuation coverage under title 
XXII of the Public Health Service Act (42 U.S.C. 
300bb–1 et seq.), section 4980B of the Internal Rev-
enue Code of 1986, or title VI of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 
1161 et seq.). 
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Subtitle B—Limitation on Applica-
tion of Federal Health Plan Re-
quirements 
SEC. 121. LIMITING APPLICATION OF REQUIREMENTS TO 
CONSUMER PROTECTIONS. 
(a) REMOVAL OF PUBLIC LAW 111–148 PLAN RE-
QUIREMENTS, OTHER THAN CERTAIN CONSUMER PRO-
TECTIONS.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, with respect to group health plans 
and health insurance coverage whether or not of-
fered through an Exchange, except as provided in 
paragraphs (2) and (3), the provisions of title 
XXVII of the Public Health Service Act (42 U.S.C. 
300gg et seq.) as in effect on the day before the date 
of the enactment of Public Law 111–148 shall apply 
instead of the provisions of such title as in effect 
after such date. 
(2) PUBLIC LAW 111–148 CONSUMER PROTEC-
TIONS CONTINUING TO BE APPLIED.—The following 
sections of the Public Health Service Act, that were 
added or amended by subtitles A and C of title I of 
Public Law 111–148, shall continue to apply to 
group health plans and to health insurance coverage 
offered in the individual and group market: 
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(A) NO LIFETIME OR ANNUAL LIMITS.— 
Section 2711 (42 U.S.C. 300gg–11; relating to 
no lifetime or annual limits), except in the case 
of limited benefit insurance (as defined in sec-
tion 122(b)). 
(B) DEPENDENT
COVERAGE
THROUGH 
AGE 26.—Section 2714 (42 U.S.C. 300bb–14; 
relating to extension of dependent coverage). 
(C) 
MODIFIED
GUARANTEED
AVAIL-
ABILITY.—Section 2702 (42 U.S.C. 300gg–1; 
relating to guaranteed availability of coverage), 
subject to paragraph (3) and subsection (c). 
(D) GUARANTEED
RENEWABILITY.—Sec-
tion 2703 (42 U.S.C. 300gg–2; relating to 
guaranteed renewability of coverage). 
(E) PROHIBITING
PRE-EXISTING
CONDI-
TION EXCLUSIONS.—Section 2704 (42 U.S.C. 
300gg–3; relating to prohibition on preexisting 
conditions). 
(F) PROHIBITING DISCRIMINATION BASED 
ON HEALTH STATUS.—Section 2705 (42 U.S.C. 
300gg–4; relating to prohibiting discrimination 
against individual participants and beneficiaries 
based on health status), subject to subsection 
(c). 
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(G) 
NON-DISCRIMINATION
IN
HEALTH 
CARE.—Section 2706 (42 U.S.C. 300gg–5; re-
lating to non-discrimination in health care). 
(3) APPLICATION
OF
A
LATE
ENROLLMENT 
PENALTY FOR THOSE WITHOUT CONTINUOUS COV-
ERAGE.— 
(A) IN GENERAL.—In the case of an indi-
vidual who seeks to enroll in health insurance 
coverage and who, as of the effective date of 
such enrollment, does not have a continuous pe-
riod of at least 12 months of creditable cov-
erage, there shall be imposed a late enrollment 
penalty in the form of an increase in the 
monthly premiums for coverage of under the 
plan of 20 percent of the monthly premium oth-
erwise determined for each consecutive full 12- 
month period (ending before such effective 
date) in which the individual was not enrolled 
in creditable coverage. Such increase shall apply 
during a period, to be specified under regula-
tions of the Secretary but in no case longer 
than 3 times the length of the most recent pe-
riod in which the individual did not have contin-
uous coverage. 
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(B) STATE WAIVER.—A State may apply 
to the Secretary for a waiver of the provisions 
of subparagraph (A) and the application of al-
ternative provisions providing incentives for 
State residents to enroll in creditable coverage 
and maintain continuous creditable coverage. 
The Secretary shall approve such waiver if the 
Secretary determines that the alternative provi-
sions provide similar or greater incentives for 
such enrollment than the incentives otherwise 
applicable. 
(4) COORDINATING IMPLEMENTATION OF PRE- 
PUBLIC LAW 111–148 PHSA PROVISIONS WITH PUBLIC 
LAW 111–148 CONSUMER PROTECTIONS.— 
(A) IN GENERAL.—In applying this sub-
section, the provisions described in paragraph 
(2) shall be treated as if they were included in 
title XXVII of the Public Health Service Act, 
as in effect before the date of enactment of 
Public Law 111–148, and, with respect to 
group health plans and health insurance cov-
erage offered in connection with such plans, in 
part 7 of subtitle B of title I of the Employee 
Retirement and Income Security Act of 1974 
(29 U.S.C. 1181 et seq.), and, with respect to 
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group health plans, in chapter 100 of the Inter-
nal Revenue Code of 1986 as follows: 
(i) LIFETIME
LIMITS; 
DEPENDENT 
COVERAGE.—The provisions described in 
paragraphs (2)(A) and (2)(B) shall be 
treated as included— 
(I) with respect to group health 
plans (and health insurance coverage 
offered with respect to such plans), 
under subpart 2 of part A of title 
XXVII of the Public Health Service 
Act (42 U.S.C. 300gg–11 et seq.) and 
subpart B of part 7 of subtitle B of 
title I of the Employee Retirement 
and Income Security Act of 1974 (29 
U.S.C. 1181 et seq.); 
(II) also with respect to group 
health plans, under subchapter B of 
chapter 100 of the Internal Revenue 
Code of 1986; and 
(III) with respect to individual 
health insurance coverage, under sub-
part 2 of part B of title XXVII of the 
Public Health Service Act (42 U.S.C. 
300gg–15 et seq.). 
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a conflict between a provision described in para-
graph (2) and a provision of law described in 
paragraph (1), the provision described in para-
graph (2) shall control and the Secretary, in 
consultation with the Secretary of the Treasury 
and the Secretary of Labor, shall establish such 
rules as may be necessary to carry out this sub-
paragraph. 
(5) CONFORMING AMENDMENTS.— 
(A) ERISA.—Section 715 of the Employee 
Retirement Income Security Act of 1974 (29 
U.S.C. 1185d) is amended— 
(i) in subsection (a), by striking ‘‘sub-
section (b)’’ and inserting ‘‘subsections (b) 
and (c)’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(c) ADDITIONAL EXCEPTION.—Pursuant to section 
121 of the Health Care Fairness for All Act, the provi-
sions of part A of title XXVII of the Public Health Service 
Act referred to in subsection (a), other than those provi-
sions specified in section 121(a)(2) of the Health Care 
Fairness for All Act, shall not apply to plans and coverage 
described in subsection (a), whether or not the plans or 
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coverage are offered through an Exchange established by 
Public Law 111–148.’’. 
(B) IRC.—Section 9815 of the Internal 
Revenue Code of 1986 is amended— 
(i) in subsection (a), by striking ‘‘sub-
section (b)’’ and inserting ‘‘subsections (b) 
and (c)’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(c) ADDITIONAL EXCEPTION.—Pursuant to section 
121 of the Health Care Fairness for All Act, the provi-
sions of part A of title XXVII of the Public Health Service 
Act referred to in subsection (a), other than those provi-
sions specified in section 121(a)(2) of the Health Care 
Fairness for All Act, shall not apply to plans described 
in subsection (a).’’. 
(b) STATE FLEXIBILITY
IN ENSURING ORDERLY 
HEALTH INSURANCE MARKET OUTSIDE
OF
AN EX-
CHANGE.— 
(1) IN GENERAL.—With respect to health insur-
ance coverage offered in a State, the State may, in 
consultation with the Secretary, take such steps, 
such as limiting the availability of general open en-
rollment periods, imposing delays in the effectiveness 
for coverage, permitting differentials in premiums 
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based on age and other factors, as the State deter-
mines necessary in order to ensure an orderly mar-
ket for health insurance coverage in the State that 
is not offered through an Exchange. Such steps may 
include the establishment of such initial open enroll-
ment period during which qualified residents may 
enroll in health insurance coverage without the im-
position of any underwriting as the State determines 
to be appropriate in ensuring initial access to such 
coverage. 
(2) FLEXIBILITY IN IMPOSING ADDITIONAL RE-
QUIREMENTS.—Subject to paragraph (5), nothing in 
this section shall be construed as preventing a State 
from continuing to apply, to health insurance cov-
erage issued in the State, requirements under the 
provisions of title XXVII of the Public Health Serv-
ice Act (as amended by subtitles A and C of title I 
of Public Law 111–148) that are not continued 
under subsection (a). 
(3) STATE FLEXIBILITY WITH RESPECT TO EX-
CHANGES.—A State may waive such provisions of 
part II of subtitle D of title I of Public Law 111– 
148 (42 U.S.C. 18031 et seq.), in relation to the es-
tablishment of an Exchange in such State, as the 
State determines appropriate in order for the State 
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to implement and administer a market-based system 
for the availability of health insurance coverage 
throughout the State. 
(4) STATE DEFAULT ENROLLMENT OPTION.— 
(A) ENROLLMENT, 
SUBJECT
TO
INDI-
VIDUAL
OPT-OUT.—Subject to subparagraph 
(D), a State may elect to provide for the enroll-
ment of residents of the State who are unin-
sured in default health insurance coverage (as 
defined in subparagraph (B)) and establishing a 
Roth HSA for such residents who do not have 
a Roth HSA unless the resident has affirma-
tively elected not to be so enrolled and not to 
have such an account, respectively. If a State 
makes such an election, the State shall permit 
eligible residents to enroll in such coverage on 
a continuous basis. 
(B) DEFAULT
HEALTH
INSURANCE
COV-
ERAGE DEFINED.—In this paragraph, the term 
‘‘default health insurance coverage’’ means, 
with respect to a State, health insurance cov-
erage that— 
(i) is a high deductible health plan 
(within the meaning of section 223(c)(2) of 
the Internal Revenue Code of 1986) with 
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prescription drug coverage limited to ge-
neric drugs for a limited number of chronic 
conditions (commonly referred to as tier I 
pharmacy benefit); 
(ii) meets such requirements as may 
apply to qualify for the payment of plan 
premiums from a health savings account 
under section 223 of such Code (such as 
age-related premiums and limitation on 
imposition of preexisting condition exclu-
sions); 
(iii) has a provider network for cov-
ered benefits that is adequate (as deter-
mined consistent with guidelines issued by 
the Secretary) to ensure access to health 
benefits under such plan; 
(iv) provides for coverage of childhood 
immunizations without cost sharing re-
quirements to the extent such immuniza-
tions have in effect a recommendation 
from the Advisory Committee on Immuni-
zation Practices of the Centers for Disease 
Control and Prevention with respect to the 
individual involved; and 
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(v) meets such other requirements as 
the State may specify. 
(C) ROTH
HSA.—In this paragraph, the 
term ‘‘Roth HSA’’ shall have the meaning given 
such term by section 530A(c) of the Internal 
Revenue Code of 1986, as added by section 
201(a) of this Act. 
(D) SIMPLE PROCESS FOR INDIVIDUALS TO 
OPT OUT.—As a condition of a State providing 
for the enrollment function described in sub-
paragraph (A), the State must establish an 
easy-to-use and transparent means by which in-
dividuals may elect not to be enrolled in default 
health insurance coverage or to have a Roth 
HSA established on the individual’s behalf, or 
both. 
(5) MINIMUM AGE VARIATION PERMITTED FOR 
PREMIUM RATES.—With respect to the premium rate 
charged by a health insurance issuer for health in-
surance coverage offered in the individual or small 
group market, a State may not limit the variation by 
age in such rate with respect to a particular plan or 
coverage involved by less than a factor of 5 to 1 for 
adults. The previous sentence shall be treated as if 
it were included in subpart I of part A of title 
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XXVII of the Public Health Service Act (42 U.S.C. 
300gg et seq.). 
(c) INAPPLICABILITY
OF
REQUIRED
ESSENTIAL 
HEALTH BENEFITS.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, no health benefits plan shall be re-
quired by reason of Federal law to comply with the 
requirements of sections 1301(a)(1)(B) and 1302 of 
Public Law 111–148 (42 U.S.C. 18021(a)(1)(B), 
18022). 
(2) STATE FLEXIBILITY.—Nothing in this sub-
section shall be construed as preventing a State 
from applying, at its option with respect to health 
insurance coverage offered through an Exchange or 
otherwise in the State, the requirements referred to 
in paragraph (1). 
(d) EFFECTIVE DATE; TRANSITION.— 
(1) IN GENERAL.—Subsection (a), (b), and (c) 
shall apply to plan years beginning after the date of 
the enactment of this Act. 
(2) SUNSETTING REQUIRED CONTRIBUTION FOR 
ACA REINSURANCE PROGRAM.—No contribution shall 
be required under section 1341 of Public Law 111– 
148 (42 U.S.C. 18061) from any group health plan 
or health insurance issuer for portions of plans years 
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occurring in months beginning more than 30 days 
after the date of the enactment of this Act. 
(e) SECRETARIAL
GUIDANCE.—The Secretary of 
Health and Human Services, in coordination with the Sec-
retary of Labor and the Secretary of the Treasury, shall 
provide such guidance as may be necessary for the coordi-
nated implementation of this section on a timely basis. 
(f) TRANSFERRING HEALTH PLAN RECORDS UPON 
CHANGING PLANS.— 
(1) IN GENERAL.—In the case of an individual 
who is covered under health insurance coverage or as 
a beneficiary or participant in a group health plan 
(as such terms are defined in section 2791 of the 
Public Health Service Act, 42 U.S.C. 300gg–91), if 
such coverage is ended and the individual obtains 
other health insurance coverage, group health plan 
coverage, or other creditable coverage (as defined for 
purposes of title XXVII of such Act), the issuer of 
the prior coverage or administrator of the prior plan 
shall forward information respecting such prior cov-
erage to the issuer of the new coverage or adminis-
trator of the new plan or coverage, as the case may 
be, subject to such rules as the Secretary establishes 
regarding the right of the beneficiary or participant 
to object to such forwarding of information. 
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(2) 
TREATMENT
AS
PLAN
REQUIREMENT 
UNDER
PHSA, ERISA, IRC.—The requirement of 
paragraph (1) shall apply as if it were a section 
under part A of title XXVII of the Public Health 
Service Act, including for purposes of applying sec-
tion 715 of the Employee Retirement Income Secu-
rity Act of 1976 (29 U.S.C. 1185d) and section 
9815 of the Internal Revenue Code of 1986. 
(g) APPLICATION OF RISK ADJUSTMENT.— 
(1) IN GENERAL.—Any issuer that offers health 
insurance coverage in the individual market in any 
of the 50 States or the District of Columbia shall 
participate in a risk adjustment mechanism under 
this subsection with respect to any health insurance 
coverage it so offers in such market, whether or not 
such coverage is offered through an Exchange. 
(2) FORM AND DESIGN OF RISK ADJUSTMENT 
MECHANISM.—The Secretary shall, in consultation 
with the National Association of Insurance Commis-
sioners and other interested parties, develop a mech-
anism to permit the adjustment of risk among 
health insurance coverage offered in the individual 
market throughout the 50 States and the District of 
Columbia. Such mechanism shall be designed to ef-
fect the same type of risk adjustment among such 
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coverage that is applicable to risk adjustment of 
payments among Medicare Advantage organizations 
under part C of title XVIII of the Social Security 
Act (42 U.S.C. 1395w–21 et seq.). 
(3) TRANSITION
FOR
NEW
COVERAGE.—The 
mechanism developed under paragraph (2) shall pro-
vide for transitional protection, over a 3-year period, 
in the case of health insurance coverage that has not 
been previously marketed. 
(4) DEVELOPMENT OF FURTHER RISK ADJUST-
MENT MECHANISM.—The Secretary shall request the 
National Association of Insurance Commissioners to 
develop a permanent model for adjustment of risk 
among health insurance issuers with respect to 
health insurance coverage offered in the individual 
market, with the intention that such a model would 
substitute for the mechanism developed under para-
graph (2). 
(5) 
TREATMENT
AS
PLAN
REQUIREMENT 
UNDER
PHSA, ERISA, IRC.—The requirement of 
paragraph (1) shall apply as if it were a section 
under part A of title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg et seq.), including for 
purposes of applying section 715 of the Employee 
Retirement Income Security Act of 1976 (29 U.S.C. 
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(B) the amount determined under para-
graph (2) for such State for that year. 
(b) APPROPRIATION.—For the purpose of making 
grants to States under this section, there is hereby appro-
priated to the Secretary, out of any funds in the Treasury 
not otherwise appropriated, for each year (beginning with 
2025) an amount equivalent to the amount determined 
under subsection (a)(3) for all States under subsection (a) 
for the year in which such fiscal year ends, subject to ad-
justment under subsection (d)(2). 
(c) GRANTS
TO STATES
FOR INDIGENT ASSIST-
ANCE.— 
(1) APPLICATION.—A State may file with the 
Secretary (in a form and manner specified by the 
Secretary) an application to provide assistance in 
furnishing health services to indigent individuals re-
siding in the State. Such application shall dem-
onstrate the manner in which such assistance is fur-
nished in an equitable manner to individuals residing 
in all parts of the State. 
(2) AMOUNT OF FUNDS.—From the funds ap-
propriated under subsection (b) for a year, the 
amount of funds paid to any State in any year 
under this section with an application filed in ac-
cordance with paragraph (1) is equal to an amount 
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