Sponsors (2)
The bill provides targeted, temporary government HSA payments and optional state protections to prevent immediate loss of coverage, while imposing new limits on HSA flexibility and substantially restricting funding and coverage for abortion and gender‑affirming care—trading expanded short‑term financial help for coverage and rights restrictions, added federal cost, and potential state administrative burdens.
People aged 18–49 on bronze or catastrophic Exchange plans and people aged 50–64 on those plans would receive monthly government HSA deposits in 2026–2027 ($1,000/mo for 18–49; $1,500/mo for 50–64), increasing cash available to pay for health care or living costs.
Those government contributions are excluded from gross income and create a new Exchange‑HSA category, allowing recipients to keep the full benefit tax‑free and build tax‑advantaged savings for future qualified medical expenses.
The benefit is targeted by tying eligibility to Exchange enrollment and income (≤700% FPL), which focuses assistance on lower‑tier plan enrollees and limits payments to those most likely to need help.
Exchange HSAs would be limited: rollovers to/from non‑Exchange HSAs would be prohibited and government contributions count against a person’s regular §223 HSA contribution limit, reducing flexibility and overall long‑term tax‑advantaged saving room.
The bill disallows HSA distributions for abortions except in cases of rape/incest or life‑endangering conditions and prohibits use of appropriated funds for plans that cover abortion (with narrow exceptions), reducing access to and financial support for abortion services.
The legislation prohibits HSA distributions for defined 'sex trait modification' procedures and excludes gender‑affirming surgeries and hormone treatments from Medicaid/CHIP and some marketplace coverage, sharply reducing access to gender‑affirming care and shifting costs onto patients—particularly low‑income people and minors.
Based on analysis of 6 sections of legislative text.
Creates Exchange plan HSAs with federal monthly payments for some Exchange enrollees, changes HSA tax rules, restricts certain reproductive and gender‑affirming services, and narrows Medicaid/CHIP eligibility and matching rules.
Introduced December 8, 2025 by Michael Dean Crapo · Last progress December 8, 2025
Creates a new type of health savings account called an "Exchange plan HSA," funds monthly cash payments to eligible adults enrolled in certain bronze or catastrophic Exchange plans for calendar years 2026–2027, changes HSA tax and contribution rules, tightens Medicaid/CHIP rules for non‑qualified immigrants and federal matching, and bans federal coverage and funding for a broad list of gender‑affirming medical and surgical procedures while carving out narrow exceptions. Effective dates vary by provision (taxable years after 2025, Medicaid changes October 1, 2026, Exchange payments 2026–2027, ACA exclusion for plan years beginning January 1, 2027).