Health Care Fairness for All Act

This bill would overhaul parts of the nation’s health insurance rules. It ends the penalties for not having coverage and for employers not offering it, while keeping core patient protections like no lifetime or annual limits, coverage for pre‑existing conditions, guaranteed renewals, and letting young adults stay on a parent’s plan to age 26 . If someone goes a year without coverage, their premiums can temporarily cost more when they sign up again, though states can choose other ways to encourage continuous coverage. States may also auto‑enroll uninsured residents into a basic high‑deductible plan and open a Roth HSA for them unless they opt out, and insurers could vary adult premiums by up to 5 to 1 based on age . Employers could reimburse workers for individual plan premiums more easily, without those arrangements being treated like group plans.

Money help would shift to a new universal health insurance tax credit that can be paid in advance to your health savings account or directly to your insurer; if you take it, you can’t also get Exchange subsidies. HSAs would become Roth‑style accounts starting in 2026, new contributions to current HSAs would stop after 2025, and the medical expense tax deduction would end after 2025 except for long‑term care premiums . Direct primary care memberships would count as an HSA‑eligible expense and would not be regulated as insurance. The bill also ensures access to short‑term health plans and makes Medicare telehealth flexibilities permanent. Medicare changes include allowing physician‑owned hospitals again and pushing “site‑neutral” payments, with separate IDs for off‑campus hospital clinics by 2026. Medicaid would move to a new funding model with a quality bonus, and the bill seeks clearer hospital prices for consumers .

• Who is affected:

  • People buying their own insurance, workers and employers, and residents enrolled by their state.
  • People on Medicare and Medicaid, and hospital and clinic providers .

• What changes:

  • Ends individual and employer coverage penalties; keeps key protections like pre‑existing condition coverage and dependent coverage to age 26 .
  • Adds a temporary late‑enrollment premium penalty after long coverage gaps; states may use other incentives instead.
  • Creates a universal health insurance tax credit; can be paid to your HSA or insurer; not stackable with Exchange subsidies.
  • Switches to Roth HSAs in 2026; ends new contributions to current HSAs and ends the medical expense deduction after 2025 (except long‑term care).
  • Lets employers reimburse workers for individual premiums; treats direct primary care memberships as HSA‑eligible and not insurance .
  • Allows wider age‑based pricing (up to 5:1); lets states auto‑enroll uninsured people; supports short‑term plans and permanent Medicare telehealth .

• When:

  • Individual mandate ends after December 31, 2024; employer mandate repeal takes effect about 30 days after enactment.
  • HSA changes and the end of the medical expense deduction start with tax years after December 31, 2025.
  • Medicare site‑neutral payment changes and separate IDs for off‑campus hospital clinics apply by January 1, 2026; telehealth flexibilities continue permanently .