I 
119TH CONGRESS 
1ST SESSION H. R. 6538 
To establish a health freedom waiver program, to promote better price 
reporting and outcomes, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 9, 2025 
Mr. PFLUGER (for himself, Mr. BEAN of Florida, Mrs. FEDORCHAK, Mr. 
BAIRD, and Mr. CLYDE) introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the Com-
mittee on Ways and Means, for a period to be subsequently determined 
by the Speaker, in each case for consideration of such provisions as fall 
within the jurisdiction of the committee concerned 
A BILL 
To establish a health freedom waiver program, to promote 
better price reporting and outcomes, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘More Affordable Care 
Act’’. 
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SEC. 2. 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 at the end 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. 
‘‘(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 
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requirements under paragraph (4) that the State in-
tends to waive and evidence that the State maintains 
a high-risk insurance pool. 
‘‘(3) STATE SUBMISSION.—A notification with 
respect to a State may be submitted by— 
‘‘(A) the governor of the State; or 
‘‘(B) the legislature of the State, upon a 
majority vote by the State legislature. 
‘‘(4) REQUIREMENTS.—The requirements 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. 
‘‘(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 
sections 36B of the Internal Revenue Code of 
1986 or under part I of subtitle E for which 
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they would otherwise be eligible, the Secretary 
shall provide for an alternative means by which 
the aggregate amount of such credits or reduc-
tions that would have been paid on behalf of 
participants in the Exchanges established under 
this title had the State not received such waiv-
er, shall be paid into the Trump Health Free-
dom Accounts established under section 223(i) 
of the Internal Revenue Code of 1986 of eligible 
residents of the State. 
‘‘(B) PAYMENTS TO TRUMP HEALTH FREE-
DOM ACCOUNTS.—The Secretary shall pay into 
the Trump Health Freedom Account of each el-
igible resident of a State for which a waiver is 
in effect for a plan 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-
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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 Secu-
rity Act, and any other Federal law relating to the 
provision of health care items or services. Such proc-
ess shall permit a State to submit a single applica-
tion for a waiver under any or all of such provisions. 
‘‘(7) EXCHANGES.— 
‘‘(A) IN GENERAL.—In the case of a State 
in which a waiver is in effect under this section 
for a plan year— 
‘‘(i) the State may— 
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‘‘(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-
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 
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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 
‘‘(ii) enrolls in a plan offered on the 
Exchange described in paragraph (7) for 
the applicable plan year. 
‘‘(B) 
SECRETARY.—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 
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‘‘(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 this is not within the authority of the Secretary. 
‘‘(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. 
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‘‘(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 yet 
attained the age of 21. 
‘‘(e) REGULATIONS.—Not later than 1 year after the 
date of enactment of the More Affordable Care Act, the 
Secretary of Health and Human Services, in coordination 
with the Secretary of the Treasury, shall promulgate 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 
sections 2701, 2702, 2703, 2704, 2705, 2708, 2711, 
2712, and 2718 of such Act.’’. 
SEC. 3. 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 ACCOUNTS.—For 
purposes of this section— 
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‘‘(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. 
‘‘(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) HEALTH INSURANCE MAY BE PURCHASED 
FROM
ACCOUNT.—Subsection (d)(2)(B) shall not 
apply. 
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‘‘(6) 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 rules of subsection (f)(5). 
‘‘(7) 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 
savings account other than a Trump Health Free-
dom Account. 
‘‘(8) RESTRICTION ON USE OF AMOUNTS.—No 
amounts in a Trump Health Freedom Account may 
be used— 
‘‘(A) to pay premiums for a health plan 
that covers— 
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‘‘(i) gender transition procedures, or 
‘‘(ii) abortion services; or 
‘‘(B) to pay for any service described in 
clause (i) or (ii) of subparagraph (A). 
‘‘(9) DEFINITIONS.—For purposes of paragraph 
(8)— 
‘‘(A) GENDER TRANSITION PROCEDURE.— 
‘‘(i) IN GENERAL.—The term ‘gender 
transition procedure’ means any hormonal 
or surgical intervention for the purpose of 
gender transition, including— 
‘‘(I) gonadotropin-releasing hor-
mone (GnRH) agonists or other pu-
berty-blocking or suppressing drugs to 
stop or delay normal puberty; 
‘‘(II) testosterone, estrogen, pro-
gesterone, or other androgens to an 
individual 
at 
doses 
that 
are 
supraphysiologic to what would nor-
mally be produced endogenously in a 
healthy individual of the same age 
and sex; 
‘‘(III) castration; 
‘‘(IV) orchiectomy; 
‘‘(V) scrotoplasty; 
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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 
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 
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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, an 
individual born with 46 XY chro-
mosomes with undervirilization, or an 
individual born having both ovarian 
and testicular tissue. 
‘‘(II) Services 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 
that has been caused by or exacer-
bated by the performance of gender 
transition procedures, whether or not 
the gender transition procedure was 
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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. 
‘‘(VI) Male circumcision. 
‘‘(B) GENDER
TRANSITION.—The term 
‘gender transition’ means the process in which 
an individual goes from identifying with or pre-
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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-
torical 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 
disruption, the reproductive system that at 
some point produces, transports, and utilizes 
sperm for fertilization. 
‘‘(F) ABORTION SERVICES.— 
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‘‘(i) IN GENERAL.—The term ‘abor-
tion services’ means— 
‘‘(I) drugs or procedures used 
with the primary intent to end the life 
of the human being in the womb, 
‘‘(II) pre-viable delivery not de-
scribed in clause (ii), and 
‘‘(III) post-viable delivery with 
intentional death of the fetus. 
‘‘(ii) EXCLUSIONS.—Such term does 
not include— 
‘‘(I) separation of the mother 
and her embryo or fetus to prevent 
the mother’s death or immediate irre-
versible bodily harm, which cannot be 
mitigated in any other way, 
‘‘(II) treatment of ectopic or 
molar pregnancy, 
‘‘(III) treatment of miscarriage, 
or 
‘‘(IV) any service described in 
clause (i) in the case of a pregnancy 
which is the result of an act of rape 
or incest.’’. 
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(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years beginning after 
December 31, 2025. 
SEC. 4. CREDIT FOR EMPLOYEE INSURANCE EXPENSES OF 
SMALL EMPLOYERS IN WAIVER STATE. 
(a) IN GENERAL.—Subsection (g) of section 45R of 
the Internal Revenue Code of 1986 is amended to read 
as follows: 
‘‘(g) CREDIT FOR SMALL EMPLOYERS IN WAIVER 
STATE.—For purposes of this section— 
‘‘(1) IN GENERAL.—In the case of an eligible 
small employer (determined with the modifications 
provided in this subsection) located in a State for 
which a waiver under section 1335 of the Patient 
Protection and Affordable Care Act is in effect, this 
section shall be applied as provided in paragraphs 
(2) through (7). 
‘‘(2) HEALTH INSURANCE CREDIT AMOUNT.— 
Subsection (b) shall be applied by substituting ‘50 
percent’ for ‘50 percent (35 percent in the case of 
a tax-exempt eligible small employer)’. 
‘‘(3) QUALIFIED PLANS.—Subsections (b) and 
(d)(4) shall be applied by treating any health plan 
authorized to be made available on an Exchange in 
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such State by section 1335(d) of such Act as a 
qualified health plan offered through an Exchange. 
‘‘(4) PHASEOUT
NOT
TO
APPLY.—Subsection 
(c) shall not apply. 
‘‘(5) ELIGIBLE SMALL EMPLOYER.—Subsection 
(d) shall be applied— 
‘‘(A) by substituting ‘50’ for ‘25’ in para-
graph (1)(A) thereof, and 
‘‘(B) without regard to subparagraph (B) 
of paragraph (1) thereof. 
‘‘(6) EMPLOYEE.—Subsection (e)(1)(A) shall be 
applied without regard to clause (i) thereof. 
‘‘(7) CREDIT PERIOD.—Subsection (e)(2) shall 
not apply, and the credit period with respect to any 
such employer shall be the period consisting of the 
1st taxable year in which the employer (or any pred-
ecessor) offers 1 or more qualified health plans to its 
employees, and any subsequent taxable year. 
‘‘(8) TAX-EXEMPT
RULES
NOT
TO
APPLY.— 
Subsection (f) shall not apply.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years beginning after 
December 31, 2025. 
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SEC. 5. PROMOTING BETTER PRICE REPORTING AND OUT-
COMES DATA. 
Not later than 90 days after the date of enactment 
of this Act, the Secretary of Health and Human Services, 
in coordination with the Secretary of the Treasury and 
the Secretary of Labor, shall update all regulations and 
guidance issued by such secretaries pursuant to Executive 
Order 13877 (84 Fed. Reg. 30849 (June 24, 2019)), in-
cluding by— 
(1) requiring the disclosure of the actual prices 
of items and services, not price estimates; 
(2) issuing updated guidance or regulations en-
suring pricing information is standardized and easily 
comparable across hospitals and health plans; 
(3) issuing guidance or proposed regulatory ac-
tion updating enforcement policies designed to en-
sure compliance with the transparent reporting of 
complete, accurate, and meaningful data; and 
(4) requiring the public reporting of outcomes 
data by providers. 
Æ 
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