Sponsors (2)
The bill provides targeted short‑term financial relief to certain Exchange enrollees through a new federally funded Exchange‑linked HSA while simultaneously restricting federal funding and coverage for abortion and a broad set of gender‑affirming services, shifting costs, administrative burdens, and eligibility consequences onto individuals and state governments.
People enrolled in bronze or catastrophic Exchange plans (ages 18–64) will receive monthly government deposits into a new Exchange-plan HSA in 2026–2027 ($1,000/month for ages 18–49; $1,500/month for ages 50–64), increasing these enrollees' ability to pay out‑of‑pocket medical costs and liquidity.
Establishes a new Exchange-plan HSA vehicle with plan-aligned accounts and allows direct monthly federal contributions (excluded from gross income), creating a targeted mechanism for consumers to save/pay medical costs through Exchange-linked HSAs.
Appropriates $10 billion per year for 2026 and 2027 to fund the Exchange-plan HSA payment program, providing a dedicated funding stream to implement the benefit in those years.
People seeking gender-affirming care (including surgeries, hormones, and certain procedures) will lose access to federally funded coverage across Marketplace plans and Medicaid/CHIP starting in 2027 and will be barred from HSA funding for specified procedures, increasing out-of-pocket costs and likely worsening unmet health and mental‑health needs for transgender individuals.
The payment program is limited to enrollees of bronze or catastrophic Exchange plans and only applies in 2026–2027, leaving many Exchange enrollees and future years without benefit and reducing the policy's reach and durability.
Minors who receive puberty blockers or gender‑related hormone therapy (except narrowly defined precocious puberty cases) will be ineligible for federally funded coverage, limiting treatment options for children and affecting parental choices.
Based on analysis of 6 sections of legislative text.
Creates an 'Exchange plan HSA' with temporary monthly payments for eligible exchange enrollees, tightens Medicaid/CHIP immigration verification and FMAP rules, and bars federal coverage/funding for specified gender‑transition procedures.
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,” provides temporary monthly cash payments in 2026–2027 to certain people enrolled in bronze or catastrophic ACA exchange plans, changes tax treatment and distribution/rollover rules for those HSAs, tightens Medicaid/CHIP verification and federal matching rules tied to immigration status, and bars federal funding and exchange coverage for a broad list of defined “gender transition” procedures with narrow medical exceptions. Key effective dates vary by provision, beginning after Dec 31, 2025 for the HSA changes, Oct 1, 2026 for Medicaid/CHIP changes, and plan years beginning Jan 1, 2027 for the gender‑transition coverage ban.