Sponsor
Roger Wayne Marshall
Senator · R-KS
Senator · R-KS
The bill increases affordability and transparency—extending enhanced tax credits, funding state reinsurance, and making prices and EOBs clearer—but does so while adding new enrollment rules, excluding certain services from coverage, and imposing substantial reporting, technical, and enforcement burdens that could raise costs or strain smaller providers.
Millions of marketplace enrollees keep expanded premium tax-credit support through 2032 and get targeted funding to lower individual-market premiums (via Healthcare Affordability Accounts and federal support for state reinsurance/high‑risk programs), which helps make coverage more affordable for low- and moderate-income households.
Consumers (insured, uninsured, and self-pay) gain much clearer, standardized price and estimate information for hospitals, labs, ASCs and many shoppable services — including published discounted cash prices and protections when self-service estimates differ from final bills — improving ability to comparison-shop and reducing surprise billing risk.
States get flexibility and prompt HHS guidance to design §1332 reinsurance/invisible high‑risk pool programs (model plan examples and 60-day guidance), making it easier for states to implement programs aimed at lowering premiums and tailoring mechanics to local markets.
Hospitals, labs, ASCs, health plans, vendors, and other providers face substantial new administrative, IT, and compliance burdens to collect, standardize, publish, and update large machine‑readable data sets and produce more detailed disclosures — costs that may be passed to patients or reduce provider financial flexibility, especially at smaller and rural providers.
The bill bars HAA funds from paying for abortion and broadly excludes 'gender transition procedures' from qualified health plans while limiting CSR support for abortion‑covering plans, which will reduce coverage and raise out‑of‑pocket costs for people seeking abortion care and gender‑affirming services.
New ID and documentation requirements for Exchange enrollees and redirecting advance premium tax credits into Healthcare Affordability Accounts add paperwork and verification steps that may create enrollment barriers, delays, and confusion for eligible people without ready access to IDs or stable documentation.
Based on analysis of 10 sections of legislative text.
Caps premium tax credit payouts by requiring minimum enrollee contributions by income tier; adds ID checks; creates HAAs; enables State high‑risk pool/reinsurance funding; strengthens hospital and ASC price transparency; requires ERISA vendor disclosures.
Official title: Lower health care costs for Americans.
Introduced December 9, 2025 by Roger Wayne Marshall · Last progress December 9, 2025
The bill reduces federal premium assistance by requiring minimum monthly enrollee contributions based on household income, adds government photo ID and other documentation for Exchange enrollment, and directs Exchanges and Treasury to create and fund new Healthcare Affordability Accounts (HAAs) for premium tax credit recipients during specified plan years. It also revises State §1332 waiver rules to allow funding invisible high‑risk pools and reinsurance programs, tightens hospital and ambulatory surgical center price‑transparency requirements with standardized machine‑readable and consumer displays, and imposes broad quarterly disclosure and anti‑confidentiality rules for ERISA health plan service providers about pricing, rebates, and payment arrangements. Taken together, the bill changes tax and subsidy rules, adds new verification and enrollment duties for Exchanges, expands state waiver flexibilities for market stabilization, strengthens provider price transparency, and requires detailed financial and contractual disclosures from third‑party health plan service vendors. Multiple provisions take effect on different dates between taxable year 2026 and mid‑2027, with some program windows limited to 2027–2031 and ERISA disclosure obligations beginning two years after enactment.