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Introduced December 9, 2025 by Roger Wayne Marshall · Last progress December 9, 2025
The bill increases consumer-facing price transparency and makes premium assistance more predictable (including expanded subsidy eligibility and state reinsurance tools) but does so at the cost of substantial new reporting burdens, enforcement penalties, privacy/competitive risks, and narrower coverage for certain services that could raise costs or create enrollment barriers for some people.
Millions of subsidy-eligible enrollees (especially low-income individuals) will receive premium tax credits paid monthly into Healthcare Affordability Accounts (HAAs), making premium assistance more predictable and easier to apply toward monthly premiums.
Patients and consumers across markets will gain far better price transparency—hospitals, ASCs, and other providers must publish negotiated rates and offer patient-specific estimated out-of-pocket costs and discounted cash prices—enabling price comparison and more informed care decisions.
States can deploy invisible high‑risk pools, reinsurance, and §1332 funding flexibly to stabilize individual market premiums and improve affordability for people with very high health costs.
Hospitals, labs, imaging centers, ASCs, health plans, PBMs, and many vendors will face large recurring administrative and IT costs to compile, update monthly, and publish detailed machine‑readable pricing and claims files, potentially raising provider burden and plan administrative expenses.
Caps on premium tax credit amounts via a new minimum monthly enrollee contribution ($10–$40) and the phasedown/limitations after 2027 reduce subsidy levels for many enrollees, likely increasing net premiums and out-of-pocket premium costs for lower- and middle-income families.
Public release of granular negotiated rates, payer/plan identifiers, and detailed claims/payment flows raises privacy and competitive risks: it could enable re-identification, contractual disputes, and unintended price coordination or market effects that may raise some prices.
Based on analysis of 10 sections of legislative text.
Modifies premium tax credit calculations and routes advance credits into Healthcare Affordability Accounts; expands state reinsurance options; requires hospital/ASC price transparency and quarterly ERISA disclosures by plan service providers.
Changes how premium tax credits work, including requiring a small minimum monthly taxpayer contribution and routing advance payments into new Healthcare Affordability Accounts (HAAs) for certain plan years. It also tightens enrollment ID checks, allows states to use waiver funds for invisible high‑risk pools or reinsurance, requires hospitals and certain ambulatory surgical centers to publish machine‑readable prices and consumer price files, and forces broad quarterly financial and pricing disclosures from health‑plan service providers to group health plans and sponsors. The bill phases in multiple new requirements with different effective dates: some tax-code changes take effect for taxable years after 2025, plan‑year HAA rules apply mainly for 2027–2031, ASC price transparency begins July 1, 2027, and ERISA disclosure rules apply for plan years starting two years after enactment. These changes increase transparency and data flows but also create new compliance tasks and may modestly reduce monthly premium assistance for some enrollees.