I 
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 Proce-
dures, 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, Edu-
cation and Workforce, and the Judiciary, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions 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 Insur-
ance Companies. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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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 establish-
ment of health savings account. 
Sec. 1015. Contributions permitted if spouse has health flexible spending ar-
rangement. 
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. 
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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 spon-
sors 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 sur-
charges. 
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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 Protec-
tion 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 para-
graph (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 de-
signed to mitigate risk to insurance premium costs. 
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‘‘(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 par-
ticipate 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 participa-
tion in the waiver program, and in such manner as 
the Secretary may require, and contain such infor-
mation as the Secretary may require, including the 
requirements under paragraph (4) that the State in-
tends to waiver and evidence that the State main-
tains 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 de-
scribed in this paragraph with respect to health in-
surance coverage within the State are as follows: 
‘‘(A) Part 1 of subtitle D. 
‘‘(B) Part 2 of subtitle D. 
‘‘(C) Section 1402. 
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‘‘(D) Sections 36B and 5000A of the In-
ternal 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, individ-
uals and small employers in the State would not 
qualify for the premium tax credits, cost-shar-
ing 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 partici-
pants 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 resi-
dents of the State. 
‘‘(B) PAYMENTS TO TRUMP HEALTH FREE-
DOM ACCOUNTS.—The Secretary shall pay into 
the Trump Health Freedom Accounts of each 
eligible resident of a State for which a waiver 
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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 Rev-
enue Code of 1986 and cost-sharing reduction 
amounts under section 1402 for the year, had 
the State not had such waiver in effect. In de-
termining the appropriate payment amount 
under this subparagraph, the Secretary shall 
calculate premium tax credit amounts and cost- 
sharing reduction amounts based on the na-
tional average annual premium amount for a 
silver tier benchmark plan among States that 
do not have such waivers in effect for the appli-
cable year. The Secretary shall make payments 
into the Trump Health Freedom Accounts of el-
igible 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 applica-
ble under the provisions of this section, and the ex-
isting waiver processes applicable under section 
1332, and titles XVIII, XIX, and XXI of the Social 
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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 ap-
plication for a waiver under any or all of such provi-
sions. 
‘‘(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 estab-
lished 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 plat-
forms described in clause (i)(II), the Sec-
retary shall operate a Federal Exchange, 
as described in section 1321(c), provided 
that any State laws regarding the avail-
ability of health plans on, and the oper-
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ation of, such Exchange shall apply in lieu 
of any provision under part 1 or part 2 
that such State has waived. 
‘‘(B) 
APPLICATION
PROGRAM
INTER-
FACE.—The Secretary shall make available to 
any State that allows for commercial platforms 
described in subparagraph (A)(i)(II), the appli-
cation 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 ‘eli-
gible resident’ means, with respect to a State 
for which a waiver is in effect under this sec-
tion, 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 Inter-
nal Revenue Code of 1986 or a cost-shar-
ing reduction under section 1402, if the 
resident enrolled in a qualified health plan 
offered on the Exchange of such State; and 
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‘‘(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 re-
lating to the provisions described in sub-
paragraph (A) through (C) of paragraph 
(4); and 
‘‘(ii) the Secretary of the Treasury 
with respect to waivers relating to the pro-
visions described in paragraph (4)(D). 
‘‘(b) WAIVER PERIOD.—Each waiver under this sec-
tion 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 sub-
section (a)(3) that submitted the notification under sub-
section (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 require-
ment that is not within the authority of the Secretary. 
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‘‘(d) AVAILABILITY OF PLANS.— 
‘‘(1) IN GENERAL.—Any health insurance cov-
erage offered in a State for which a waiver under 
this section is in effect, and authorized by the insur-
ance commissioner of the State, shall be made avail-
able on, as applicable, the Federal or State Ex-
change or commercial platforms described in sub-
section (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 at-
tained 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 regu-
lations to carry out this section. 
‘‘(f) RULE
OF CONSTRUCTION REGARDING CON-
SUMER 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 
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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 Rev-
enue Code of 1986 is amended by adding at the end the 
following new subsection: 
‘‘(i) TRUMP
HEALTH
FREEDOM
AC-
COUNTS.—For purposes of this section— 
‘‘(1) IN GENERAL.—In the case of a Trump 
Health Freedom Account, this section shall be ap-
plied 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 in-
dividual residing in a State for which a waiver under 
section 1335 of the Patient Protection and Afford-
able 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. 
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‘‘(4) TREATMENT OF TRANSFERRED CONTRIBU-
TIONS.—Amounts transferred to a Trump Health 
Freedom Account pursuant to section 1335(a)(5) of 
such Act shall not be taken into account in deter-
mining the deduction allowed by subsection (a). 
‘‘(5) ACCOUNT MUST BE ONLY HSA OF INDI-
VIDUAL.— 
‘‘(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. 
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‘‘(XXII) tubal ligation; 
‘‘(XXIII) sterilization; 
‘‘(XXIV) any plastic, cosmetic, or 
aesthetic surgery that feminizes or 
masculinizes the facial or other phys-
iological 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 re-
gion; 
‘‘(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 
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of such individual or, if applicable, such in-
dividual’s parents or legal guardian: 
‘‘(I) Services to individuals born 
with a medically verifiable disorder of 
sex development, including an indi-
vidual with external sex characteris-
tics that are irresolvably ambiguous 
such as an individual born with 46 
XX chromosomes with virilization, 
and individual born with 46 XY chro-
mosomes 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 nor-
mal 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 in-
fection, injury, disease, or disorder 
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that has been caused by or exacer-
bated 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 pro-
cedure is permissible under this sec-
tion. 
‘‘(IV) Any procedure undertaken 
because the individual suffers from a 
physical disorder, physical injury, or 
physical illness (but not mental, be-
havioral, or emotional distress or a 
mental, behavioral, or emotional dis-
order) that would, as certified by a 
physician, place the individual in im-
minent 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 pu-
berty. 
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‘‘(VI) Male circumcision. 
‘‘(B) GENDER
TRANSITION.—The term 
‘gender transition’ means the process in which 
an individual goes from identifying with or pre-
senting 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 in-
dividual who naturally has, had, will have, or 
would have, but for a congenital anomaly, his-
toric 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 indi-
vidual who naturally has, had, will have, or 
would have, but for a congenital anomaly, his-
torical accident, or intentional or unintentional 
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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 MEDI-
CARE BY REASON OF AGE ALLOWED TO CON-
TRIBUTE 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
PUR-
CHASED FROM ACCOUNT.—Section 223(d)(2)(C)(iv) is 
amended by inserting ‘‘and who is not an eligible indi-
vidual’’ after ‘‘who has attained the age specified in sec-
tion 1811 of the Social Security Act’’. 
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(c) COORDINATION WITH PENALTY ON DISTRIBU-
TIONS
NOT
USED
FOR
QUALIFIED
MEDICAL
EX-
PENSES.—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 ‘‘So-
cial Security Act’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to months beginning after Decem-
ber 31, 2025. 
SEC. 1012. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CON-
TRIBUTIONS 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 individ-
uals who are married to each other, if both 
spouses are eligible individuals and either 
spouse has family coverage under a high de-
ductible health plan as of the first day of any 
month— 
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‘‘(i) the limitation under paragraph 
(1) shall be applied by not taking into ac-
count 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 ac-
count), 
‘‘(ii) such limitation (after application 
of clause (i)) shall be reduced by the ag-
gregate 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
CON-
TRIBUTION AMOUNTS.—If both spouses referred 
to in subparagraph (A) have attained age 55 
before the close of the taxable year, the limita-
tion referred to in subparagraph (A)(iii) which 
is subject to division between the spouses shall 
include the additional contribution amounts de-
termined under paragraph (3) for both spouses. 
In any other case, any additional contribution 
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amount determined under paragraph (3) shall 
not be taken into account under subparagraph 
(A)(iii) and shall not be subject to division be-
tween 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 pur-
poses 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 di-
rectly to a health savings account of such em-
ployee if— 
‘‘(i) such distribution is made in con-
nection 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 
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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 aggre-
gate amount of distributions from health flexi-
ble spending arrangements and health reim-
bursement 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 ex-
ceed the dollar amount in effect under section 
125(i)(1) (twice such amount in the case of cov-
erage 
which 
is 
described 
in 
section 
223(b)(2)(B)).’’. 
(b) PARTIAL REDUCTION OF LIMITATION ON DE-
DUCTIBLE 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 subpara-
graph (C) the following new subparagraph: 
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‘‘(D) so much of any qualified HSA dis-
tribution (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 ar-
rangement 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 ARRANGE-
MENT
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 ar-
rangement 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 
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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 amend-
ed by the preceding provisions of this Act, is amend-
ed 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 para-
graph (20) the following new paragraph: 
‘‘(21) the amount of any qualified HSA dis-
tribution (as defined in section 106(e)(2)) with re-
spect 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 Decem-
ber 31, 2025. 
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SEC. 1014. SPECIAL RULE FOR CERTAIN MEDICAL EX-
PENSES 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 bene-
ficiary under a high deductible health plan be-
gins, 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 
ARRANGE-
MENT. 
(a) CONTRIBUTIONS PERMITTED IF SPOUSE HAS A 
HEALTH FLEXIBLE SPENDING ARRANGEMENT.—Section 
223(c)(1)(B), as amended by this preceding provisions of 
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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 ar-
rangement if the aggregate reimburse-
ments 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 ex-
penses paid or incurred with respect to 
such individual.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to plan years beginning after De-
cember 31, 2025. 
SEC. 1016. INCREASE IN HEALTH SAVINGS ACCOUNT CON-
TRIBUTION LIMITATION FOR CERTAIN INDI-
VIDUALS. 
(a) INCREASE.— 
(1) IN GENERAL.—Section 223(b) is amended 
by adding at the end the following new paragraph: 
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‘‘(9) INCREASE
IN
LIMITATION
FOR
CERTAIN 
TAXPAYERS.— 
‘‘(A) IN GENERAL.—The applicable limita-
tion under subparagraphs (A) and (B) of para-
graph (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). 
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For purposes of the preceding sentence, ad-
justed gross income shall be determined in the 
same manner as under section 219(g)(3)(A), 
except determined without regard to any deduc-
tion allowed under this section.’’. 
(2) ONLY TO APPLY TO EMPLOYEE CONTRIBU-
TIONS.—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 amend-
ed— 
(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 para-
graph (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 para-
graph (1)(B)(iii) and inserting ‘‘, and’’, and 
(5) by inserting after paragraph (1)(B)(iii) the 
following new clause: 
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‘‘(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 begin-
ning after December 31, 2025. 
(2) SUBSECTION (B).—The amendments made 
by subsection (b) shall apply to taxable years begin-
ning after December 31, 2026. 
SEC. 1017. HEALTH SAVINGS ACCOUNTS USED TO PUR-
CHASE 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 sub-
paragraph (C). 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to plan years beginning after De-
cember 31, 2025. 
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Subtitle C—Health Care Sharing 
Ministries 
SEC. 1018. TREATMENT OF HEALTH CARE SHARING MIN-
ISTRIES. 
(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 pro-
visions of this Act, is further amended by adding at the 
end the following new subparagraph: 
‘‘(D) INCLUSION OF HEALTH CARE SHAR-
ING MINISTRIES.—The term ‘qualified medical 
expenses’ shall include amounts paid by a mem-
ber of a health care sharing ministry (as de-
fined in section 5000A(d)(2)(B)(ii) without re-
gard to subclause (IV) thereof) for— 
‘‘(i) the sharing of medical expenses 
among members, and 
‘‘(ii) administrative fees of the min-
istry.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
the date of enactment of this Act. 
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SEC. 1019. HEALTH CARE SHARING MINISTRY FEES TREAT-
ED 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 
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5000A(d)(2)(B)(ii) without regard to subclause (IV) 
thereof) shall not be treated as health plan or insur-
ance 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 EM-
PLOYERS. 
(a) IN GENERAL.—Section 3(5) of the Employee Re-
tirement 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 treat-
ed as an ‘employer’, regardless of whether the 
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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 aggre-
gated and counted together as de-
scribed in subparagraph (D); 
‘‘(III) has been actively in exist-
ence for at least 2 years; 
‘‘(IV) has been formed and main-
tained in good faith for purposes 
other than providing medical care (as 
defined in section 733(a)(2)) through 
the purchase of insurance or other-
wise; 
‘‘(V) does not condition member-
ship in the group or association on 
any health status-related factor (as 
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described in section 702(a)(1)) relat-
ing to any individual; 
‘‘(VI) makes coverage under such 
plan available to all employer mem-
bers of such group or association re-
gardless 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 em-
ployer member of such group or asso-
ciation; 
‘‘(VIII) has established a gov-
erning 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 partici-
pating in the plan that are duly elect-
ed by each participating employer 
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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 con-
trolled 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 in-
surance 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 treat-
ment 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 Sec-
retary by regulation may provide. 
‘‘(C)(i) For purposes of subparagraph (B), 
a self-employed individual shall be treated as— 
‘‘(I) an employer who may be-
come a member of a group or associa-
tion of employers; 
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‘‘(II) an employee who may par-
ticipate 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 subpara-
graph, 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, regard-
less of whether such trade or business 
is incorporated or unincorporated; 
‘‘(III) earns wages (as defined in 
section 3121(a) of the Internal Rev-
enue Code of 1986) or self-employ-
ment 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 
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personal services to such trade or 
business. 
‘‘(iii) The board of a group or associa-
tion 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 pur-
poses of being treated as an— 
‘‘(aa) employer member of 
such group or association (in ac-
cordance with clause (i)(I)); and 
‘‘(bb) employee who may 
participate in the employee wel-
fare benefit plan established and 
maintained by such group or as-
sociation (in accordance with 
clause (i)(II)); 
‘‘(II) through reasonable moni-
toring procedures, periodically deter-
mine 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 
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plan coverage available to such indi-
vidual (or dependents thereof) for any 
plan year following the plan year dur-
ing which the board makes such de-
termination. If, subsequent to a deter-
mination that an individual no longer 
meets such requirements, such indi-
vidual furnishes evidence of satisfying 
such requirements, such individual 
(and dependents thereof) shall be eli-
gible to receive plan coverage. 
‘‘(D) For purposes of subparagraph (B), 
all of the employees (including self-employed in-
dividuals) 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 arrange-
ment; and 
‘‘(ii) aggregated and counted together 
for purposes of any regulation of an em-
ployee welfare benefit plan established and 
maintained by such group or association.’’. 
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(b) DETERMINATION OF EMPLOYER OR JOINT EM-
PLOYER STATUS.—The provision of employee welfare ben-
efit plan coverage by a group or association of employers 
shall not be construed as evidence for establishing an em-
ployer or joint employer relationship under any Federal 
or State law. 
SEC. 2003. RULES APPLICABLE TO EMPLOYEE WELFARE 
BENEFIT PLANS ESTABLISHED AND MAIN-
TAINED BY A GROUP OR ASSOCIATION OF 
EMPLOYERS. 
Part 7 of subtitle B of title I of the Employee Retire-
ment 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 MAIN-
TAINED BY A GROUP OR ASSOCIATION OF 
EMPLOYERS. 
‘‘(a) PREMIUM RATES FOR A GROUP OR ASSOCIA-
TION OF EMPLOYERS.— 
‘‘(1)(A) In the case of an employee welfare ben-
efit 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— 
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‘‘(i) establish base premium rates 
formed on an actuarially sound, modified 
community rating methodology that con-
siders 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. 
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‘‘(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 as-
sociation 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 CONDI-
TION 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 (includ-
ing continued eligibility) of any individual (including 
an employee of an employer member or a self-em-
ployed 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 
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such individual (consistent with the rules under sec-
tion 702(a)(1)); 
‘‘(2) requiring an individual (including an em-
ployee of an employer member or a self-employed in-
dividual, or a dependent of such employee or self- 
employed individual), as a condition of enrollment or 
continued enrollment under the plan, to pay a pre-
mium or contribution that is greater than the pre-
mium or contribution for a similarly situated indi-
vidual enrolled in the plan based on any health sta-
tus-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 Serv-
ice 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 
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A of title XXVII of the Public Health Service Act as incor-
porated 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 AR-
RANGEMENTS 
INTEGRATED 
WITH 
INDI-
VIDUAL MARKET COVERAGE. 
(a) IN GENERAL.—Section 9815(b) is amended— 
(1) By striking ‘‘exception Notwithstanding 
subsection (a)’’ and inserting the following: ‘‘Excep-
tions.— 
‘‘(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 indi-
vidual care expense arrangement shall be treat-
ed as meeting the requirements of section 9802 
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and sections 2705, 2711, 2713, and 2715 of 
title XXVII of the Public Health Service Act. 
‘‘(B) CUSTOM HEALTH OPTION AND INDI-
VIDUAL
CARE
EXPENSE
ARRANGEMENTS
DE-
FINED.—For purposes of this section, the term 
‘custom health option and individual care ex-
pense arrangement’ means a health reimburse-
ment arrangement— 
‘‘(i) which is an employer-provided 
group health plan funded solely by em-
ployer 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 dur-
ing which the individual is covered— 
‘‘(I) under individual health in-
surance coverage (other than coverage 
that consists solely of excepted bene-
fits), or 
‘‘(II) under part A and B of title 
XVIII of the Social Security Act or 
part C of such title, 
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‘‘(iii) which meets the nondiscrimina-
tion requirements of subparagraph (C), 
‘‘(iv) which meets the substantiation 
requirements of subparagraph (D), and 
‘‘(v) which meets the notice require-
ments of subparagraph (E). 
‘‘(C) NONDISCRIMINATION.— 
‘‘(i) IN
GENERAL.—An arrangement 
meets the requirements of this subpara-
graph if an employer offering such ar-
rangement to an employee within a speci-
fied 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 ac-
count-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 mar-
ket (that is subject to section 2701 of the 
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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
EM-
PLOYEE.—For purposes of this subpara-
graph, any of the following may be des-
ignated 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 rat-
ing area. 
‘‘(VI) Employees who are in-
cluded in a unit of employees covered 
under a collective bargaining agree-
ment 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 in-
surance issuer offering group health 
insurance coverage, waiting period re-
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quirement that satisfies section 2708 
of the Public Health Service Act. 
‘‘(VIII) Seasonal employees. 
‘‘(IX) Employees who are non-
resident 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 em-
ployees as the Secretary may des-
ignate. 
An employer may designate (in such man-
ner as is prescribed by the Secretary) two 
or more of the classes described in the pre-
ceding subclauses as the specified class of 
employees to which the arrangement is of-
fered for purposes of applying this sub-
paragraph. 
‘‘(iii) 
SPECIAL
RULE
FOR
NEW 
HIRES.—An employer may designate pro-
spectively so much of a specified class of 
employees as are hired after a date set by 
the employer. Such subclass of employees 
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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 em-
ployees 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 de-
pendents of the employee are covered 
under the arrangement, and 
‘‘(II) increases with respect to a 
participant as the age of the partici-
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pant increases, but not in excess of an 
amount equal to 300 percent of the 
lowest maximum dollar amount with 
respect to such a participant deter-
mined without regard to age. 
‘‘(D) SUBSTANTIATION REQUIREMENTS.— 
An arrangement meets the requirements of this 
subparagraph if the arrangement has reason-
able procedures to substantiate— 
‘‘(i) that the participant and any de-
pendents are, or will be, enrolled in cov-
erage described in subparagraph (B)(ii) as 
of the beginning of the plan year of the ar-
rangement (or as of the beginning of cov-
erage 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.— 
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‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (iii), an arrangement meets 
the requirements of this subparagraph if, 
under the arrangement, each employee eli-
gible 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 arrange-
ment which— 
‘‘(I) is sufficiently accurate and 
comprehensive to apprise the employee 
of such rights and obligations, and 
‘‘(II) is written in a manner cal-
culated to be understood by the aver-
age employee eligible to participate. 
‘‘(ii) NOTICE
REQUIREMENTS.—Such 
notice shall include such information as the 
Secretary may by regulation prescribe. 
‘‘(iii) NOTICE
DEADLINE
FOR
CER-
TAIN EMPLOYEES.—In the case of an em-
ployee— 
‘‘(I) who first becomes eligible to 
participate in the arrangement after 
the date notice is given with respect 
to the plan under clause (i) (deter-
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mined without regard to this clause), 
or 
‘‘(II) whose employer is first es-
tablished 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 re-
quired under clause (i) is provided not 
later than the date the arrangement may 
take effect with respect to such em-
ployee.’’. 
(b) INCLUSION OF CHOICE ARRANGEMENT PER-
MITTED BENEFITS ON W–2.— 
(1) IN GENERAL.—Section 6051(a), as amend-
ed by the preceding provisions of this Act, is amend-
ed 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 para-
graph (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 em-
ployee.’’. 
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(c) TREATMENT OF CURRENT RULES RELATING TO 
CERTAIN ARRANGEMENTS.— 
(1) NO INFERENCE.—To the extent not incon-
sistent with the amendments made by this section— 
(A) no inference shall be made from such 
amendments with respect to the rules pre-
scribed in the Federal Register on June 20, 
2019 (84 Fed. Reg. 28888), relating to health 
reimbursement arrangements and other ac-
count-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 includ-
ing a reference to individual coverage health re-
imbursement arrangements. 
(2) OTHER CONFORMING OF RULES.—The Sec-
retary 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 De-
cember 31, 2025. 
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SEC. 2013. PARTICIPANTS IN CHOICE ARRANGEMENT ELI-
GIBLE FOR PURCHASE OF EXCHANGE INSUR-
ANCE 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 par-
ticipating in a custom health option and indi-
vidual 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 ARRANGE-
MENT. 
(a) IN GENERAL.—Subpart D of part IV of sub-
chapter A of chapter 1 is amended by adding at the end 
the following new section: 
‘‘SEC. 45BB. EMPLOYER CREDIT FOR CHOICE ARRANGE-
MENT. 
‘‘(a) IN GENERAL.—For purposes of section 38, in 
the case of an eligible employer, the CHOICE arrange-
ment credit determined under this section for any taxable 
year is an amount, with respect to each employee enrolled 
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during the credit period in a CHOICE arrangement main-
tained 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 pe-
riod. 
‘‘(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 with-
out 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 sec-
tion 5000A(f)(2)). 
‘‘(c) DEFINITIONS.—For purposes of this section— 
‘‘(1) 
CHOICE 
ARRANGEMENT.—The 
term 
‘CHOICE arrangement’ means a custom health op-
tion and individual care expense arrangement (as de-
fined in section 9815(b)(2)(B)). 
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‘‘(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 deter-
mined under section 1(f)(3) for the calendar 
year in which such taxable year begins by sub-
stituting ‘calendar year 2025’ for ‘calendar year 
2016’ in subparagraph (A)(ii) thereof. 
‘‘(2) ROUNDING.—If any amount after adjust-
ment under paragraph (1) is not a multiple of $10, 
such amount shall be rounded to the next lower mul-
tiple of $10.’’. 
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(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 add-
ing at the end the following new paragraph: 
‘‘(42) the CHOICE arrangement credit deter-
mined under section 45BB(a).’’. 
(c) CREDIT ALLOWED AGAINST ALTERNATIVE MIN-
IMUM 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 sec-
tion 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. 
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Subtitle C—Self-Insurance 
Protection Act 
SEC. 2021. SHORT TITLE. 
This Act may be cited as the ‘‘Self-Insurance Protec-
tion Act’’. 
SEC. 2022. FINDINGS. 
Congress finds the following: 
(1) Small and large employers offer health ben-
efit plan coverage to employees in self-funded ar-
rangements 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 fi-
nancial risk management tool to protect against ex-
cess 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 unfore-
seen health plan claims, does not insure the em-
ployee health benefit plan itself, and does not pay 
health care providers for medical services provided to 
the employees. 
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(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 in-
surance 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 as-
sets 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 OB-
TAINED BY CERTAIN PLAN SPONSORS OF 
GROUP 
HEALTH 
PLANS 
NOT 
INCLUDED 
UNDER THE DEFINITION OF HEALTH INSUR-
ANCE COVERAGE. 
Section 733(b)(1) of the Employee Retirement In-
come 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 
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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 ob-
tained 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 pre-
vent an employee benefit plan that is a group health 
plan from insuring against the risk of excess or un-
expected health plan claims losses.’’. 
Subtitle D—Small Business 
Flexibility Act 
SEC. 2031. SHORT TITLE. 
This Act may be cited as the ‘‘Small Business Flexi-
bility Act’’. 
SEC. 2032. NOTIFICATION OF FLEXIBLE HEALTH INSUR-
ANCE 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: 
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‘‘SEC. 9835. NOTIFICATION OF FLEXIBLE HEALTH INSUR-
ANCE BENEFITS. 
‘‘(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this section, the Secretary shall no-
tify 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 sec-
tion 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 Em-
ployee Retirement Income Security Act (29 U.S.C. 
1002(5)). 
‘‘(2) FLEXIBLE
HEALTH
INSURANCE
BENE-
FITS.—The term ‘flexible health insurance benefits’ 
means— 
‘‘(A) an individual contribution health re-
imbursement arrangement (as described in the 
rule entitled ‘Health Reimbursement Arrange-
ments and Other Account-Based Group Health 
Plans’ (84 Fed. Reg. 28888 (June 20, 2019))); 
‘‘(B) a qualified small employer health re-
imbursement arrangement (as defined in sec-
tion 9831(d)(2)); and 
‘‘(C) the small employer health insurance 
credit determined under section 45R.’’. 
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(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 DURA-
TION 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 INSUR-
ANCE.—The term ‘short-term limited duration insur-
ance’ 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 exten-
sions) after the original effective date of the 
contract.’’. 
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Subtitle F—IMPACT Act of 2025 
SEC. 2051. SHORT TITLE. 
This Act may be cited as the ‘‘Improved Medical Pa-
tients Affordable Care Today Act of 2025’’ or the ‘‘IM-
PACT 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 pe-
riod at the end and inserting ‘‘; or’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) with respect to the plan year involved, 
is determined to be ineligible (or reasonably ex-
pects to be ineligible) for the premium tax cred-
it 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 begin-
ning on or after January 1, 2026. 
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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-EX-
CHANGE PLANS. 
‘‘(a) IN GENERAL.—There is established a Reinsur-
ance 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 pro-
viding 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 
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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.—Appro-
priated 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 en-
actment of this section). 
‘‘(c) OPERATION OF PROGRAM.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish 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. 
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‘‘(3) DEFINITIONS.—In this section: 
‘‘(A) COVERED PLAN.—The term ‘covered 
plan’ means individual health insurance cov-
erage (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 de-
scribed 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 annu-
ally establish an attachment point, payment propor-
tion, and reinsurance cap with respect to claims for 
eligible individuals for payments under the Reinsur-
ance Program, consistent with the following: 
‘‘(A) The attachment point for the period 
beginning January 1, 2026, and ending Decem-
ber 31, 2026, shall be $110,000. 
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‘‘(B) The payment proportion for the pe-
riod 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 Decem-
ber 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 
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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 Afford-
able Care Act (42 U.S.C. 18021(a)(1)) is amend-
ed— 
(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.’’. 
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(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 LIMITA-
TION FOR CERTAIN PLANS.— 
(1) IN GENERAL.— 
(A) REMOVAL OF LIMITATION FOR CER-
TAIN 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 re-
spect to plan years beginning on or after Janu-
ary 1, 2026. 
(2) MAINTAINING
AGE
PREMIUM
VARIATION 
LIMITATION FOR QUALIFIED HEALTH PLANS.—Sec-
tion 1301(a)(1) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18021(a)(1)), as 
amended by subsection (b), is further amended— 
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(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 cov-
erage has made the election described in section 
1312(c)(1)(A) of the Patient Protection and Affordable 
Care Act (as inserted by subsection (b)). 
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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-POCK-
ET 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 fol-
lowing requirements are met: 
‘‘(1) The item or service furnished by such pro-
vider or facility without a contract in effect with 
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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 fur-
nished; 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 
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percentile described in subsection (a)(2)(B) to all individ-
uals 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 dis-
close 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 
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without benefits under any such plan, coverage, or pro-
gram 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 facil-
ity 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 EN-
ROLLING IN EXCHANGES.—Section 1311 of the Patient 
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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 in-
serting the following: 
‘‘(A) IN GENERAL.—The Secretary’’; 
(C) by redesignating subparagraphs (B) 
through (D) as clauses (i) through (iii) respec-
tively, and adjusting the margins accordingly; 
(D) in clause (i), as so redesignated, by 
striking ‘‘periods, as determined by the Sec-
retary for calendar years after the initial enroll-
ment period;’’ and inserting the following: ‘‘pe-
riods for plans offered in the individual mar-
ket— 
‘‘(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;’’. 
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(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 spe-
cial enrollment period for an individual on the 
basis of the relationship of the income of such 
individual to the poverty line, other than a spe-
cial enrollment period based on a change in cir-
cumstances 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 enroll-
ment for plan years beginning on or after January 
1, 2027— 
‘‘(A) an annual open enrollment period 
other than the period described in subpara-
graph (A)(i) of subsection (c)(6); or 
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(b) VERIFYING
INCOME
FOR
INDIVIDUALS
EN-
ROLLED 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
IN-
COME AND FAMILY SIZE WHEN TAX DATA IS 
UNAVAILABLE.—For plan years beginning on or 
after January 1, 2027, for purposes of subpara-
graph (A), in the case that the Exchange re-
quests 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 in-
dividual with respect to such household income, 
and the Exchange shall take the actions de-
scribed in subparagraph (A). 
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‘‘(D) REQUIRING
VERIFICATION
OF
IN-
COME IN THE CASE OF CERTAIN INCOME DIS-
CREPANCIES.— 
‘‘(i) IN GENERAL.—Subject to clause 
(iii), for plan years beginning on or after 
January 1, 2027, for purposes of subpara-
graph (A), in the case that a specified in-
come discrepancy described in clause (ii) of 
this subparagraph exists with respect to 
the information provided by an applicant 
under subsection (b)(3), the household in-
come of such individual shall be treated as 
inconsistent 
with 
information 
in 
the 
records maintained by persons under sub-
section (c), or as not verified under sub-
section (d), and the Exchange shall take 
the actions described in such subparagraph 
(A). 
‘‘(ii) SPECIFIED
INCOME
DISCREP-
ANCY.—For purposes of clause (i), a speci-
fied income discrepancy exists with respect 
to the information provided by an appli-
cant under subsection (b)(3) if— 
‘‘(I) the applicant attests to a 
projected annual household income 
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that would qualify such applicant to 
be an applicable taxpayer under sec-
tion 36B(c)(1)(A) of the Internal Rev-
enue 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 house-
hold 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 an-
nual household income exceeds the in-
come reflected in the data described in 
subclause (II) by a reasonable thresh-
old 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 as-
sessed or determined based on the 
data described in subclause (II) that 
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the household income of the applicant 
meets the applicable income-based eli-
gibility standard for the Medicaid pro-
gram 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 INDI-
VIDUALS 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 el-
igible for the Medicaid program under title 
XIX of the Social Security Act by reason 
of such alien status.’’. 
(2) REQUIRING
INDIVIDUALS
ON
WHOSE
BE-
HALF 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 fol-
lowing new paragraph: 
‘‘(3) ANNUAL REQUIREMENT TO FILE AND REC-
ONCILE.— 
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‘‘(A) IN GENERAL.—For plan years begin-
ning on or after January 1, 2027, in the case 
of an individual with respect to whom any ad-
vance payment of the premium tax credit allow-
able 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 rel-
evant 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 Ex-
change determines, based on information pro-
vided by the Secretary of the Treasury, that 
such individual— 
‘‘(i) has not filed an income tax re-
turn, as required under section 6011 and 
6012 of such code (and implementing reg-
ulations), for the relevant prior tax year; 
or 
‘‘(ii) as necessarily, has not been rec-
onciled (in accordance with subsection (f) 
of such section 36B) the advance payment 
of the premium tax credit made with re-
spect to such individual for such relevant 
prior tax year. 
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‘‘(B) RELEVANT
PRIOR
TAX
YEAR.—For 
purposes of subparagraph (A), the term ‘rel-
evant 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 indi-
vidual (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 require-
ments to file an income tax return for the rel-
evant prior tax year and, as necessary, to rec-
oncile 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 deter-
mination of eligibility with respect to such indi-
vidual and may delay for a reasonable period 
(as determined by the Secretary) any deter-
mination based on information provided by the 
Secretary of the Treasury that such individual 
has not fulfilled such requirements. 
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‘‘(D) NOTICE.—If the Secretary deter-
mines that an individual did not meet the re-
quirements described in subparagraph (A) with 
respect to the relevant prior tax year and noti-
fies the Exchange of such determination, the 
Exchange shall comply with the notification re-
quirement 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 PE-
RIOD TO RESOLVE INCOME INCONSISTENCIES.—The 
Secretary of Health and Human Services shall revise 
section 155.315(f) of title 45, Code of Federal Regu-
lations, 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 sec-
tion 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 re-
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quired 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 al-
lowable variation in the actuarial value of a health 
plan applicable under such section shall be the allow-
able 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 de-
scribed 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’’ 
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means a minus 1 percentage point and plus 1 per-
centage point allowable actuarial value variation. 
(d) UPDATING PREMIUM ADJUSTMENT PERCENTAGE 
METHODOLOGY.—Section 1302(c)(4) of the Patient Pro-
tection 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 sub-
paragraph: 
‘‘(B) UPDATE
TO
METHODOLOGY.—For 
calendar years beginning with 2027, the pre-
mium adjustment percentage under this para-
graph for such calendar year shall be deter-
mined consistent with the methodology pub-
lished 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 begin-
ning on or after January 1, 2027, the gross premium per-
centage-base premium payment threshold policy described 
in paragraph (2) of such section and the fixed-dollar pre-
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mium 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 Pro-
tection 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 
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(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 sub-
paragraph: 
‘‘(C) REDUCTION
IN
ADVANCE
PAYMENT 
FOR SPECIFIED REENROLLED INDIVIDUALS.— 
‘‘(i) IN GENERAL.—The amount of an 
advance payment made under subpara-
graph (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 subpara-
graph reduced by $5 (or such higher 
amount as the Secretary determines appro-
priate). 
‘‘(ii) DEFINITIONS.—In this subpara-
graph: 
‘‘(I) APPLICABLE
MONTH.—The 
term ‘applicable month’ means, with 
respect to a specified reenrolled indi-
vidual, any month during a plan year 
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