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Creates a new HHS‑administered Exchange HSA program that pays monthly contributions to adults enrolled in bronze or catastrophic Exchange plans in 2026–2027, changes tax treatment and rollover rules for those HSAs, and restricts use of HSA funds for most abortions and a wide set of gender‑transition procedures. It also changes ACA rules to let all individual‑market enrollees buy catastrophic/lower value plans, directs funding for cost‑sharing reductions with limits on abortion coverage, and tightens when federal Medicaid/CHIP matching funds are available for care provided to individuals without verified immigration status. The bill amends the tax code, the Affordable Care Act, and the Social Security Act; it authorizes and appropriates funds for the HSA payments, creates new definitions and coverage prohibitions for gender‑transition procedures, and gives states an option about continuing certain benefits to non‑qualified aliens while removing federal matching for most such coverage unless a state affirmatively elects to continue it.
The bill delivers targeted, tax‑free HSA payments and expands lower‑premium plan options for some consumers while imposing new coverage limits (notably on abortion and gender‑affirming care), tightening immigrant Medicaid rules, and adding administrative and fiscal costs.
People ages 18–64 who enroll in bronze or catastrophic Exchange plans will receive monthly, tax‑exempt HSA payments (2026–2027) that lower out‑of‑pocket costs for enrollees.
All individual‑market enrollees will be able to buy catastrophic or lower‑actuarial‑value plans beginning in 2027, expanding low‑premium plan choices for consumers.
Congress provides dedicated HHS appropriations (e.g., $10 billion per year) to ensure funding and timely implementation of the payment program, supporting benefit delivery to enrollees.
Women would be prevented from using Exchange HSA funds to pay for most abortions and QHPs that cover abortion risk losing CSR payments, likely reducing abortion coverage options and increasing out‑of‑pocket costs for many women.
The bill prohibits federal coverage of gender‑affirming surgeries and most hormone/pubertal treatments on Exchanges and in Medicaid/CHIP, sharply reducing access and increasing costs for transgender people — especially minors — and complicating coverage for related reconstructive or follow‑up care.
Non‑qualified aliens (except certain children and pregnant people) will lose access to federally funded Medicaid/CHIP unless their State opts in, and removing federal continuation during verification periods can cause coverage gaps and care interruptions for immigrants while imposing difficult state policy choices.
Introduced December 8, 2025 by Michael Dean Crapo · Last progress December 8, 2025