Sponsor
Roger Wayne Marshall
Senator · R-KS
Senator · R-KS
Official title: Lower health care costs for Americans.
Introduced December 9, 2025 by Roger Wayne Marshall · Last progress December 9, 2025
The bill increases near‑term affordability for many through extended credits, state reinsurance funding, and much stronger price transparency — but it also imposes new verification and coverage limits and substantial administrative, technical, and enforcement burdens that could raise costs, create access barriers for vulnerable groups, and strain smaller providers.
Consumers (insured, uninsured, and self-pay patients) gain far clearer, standardized price information across hospitals, labs, ambulatory surgical centers, and plans — including machine‑readable files, consumer displays for shoppable services, and enforceable discounted cash prices — helping people compare costs, avoid surprise bills, and potentially lower out‑of‑pocket spending.
Low- and moderate-income enrollees keep expanded premium tax credit support (extended through 2032) and new mechanisms (Healthcare Affordability Accounts plus dedicated funding and federal support for state reinsurance/high‑risk programs) that help lower individual-market premiums and make coverage more affordable.
States get clearer, faster federal support and flexibility to design §1332 reinsurance or invisible high‑risk pool programs (model plans and HHS guidance), allowing tailoring to local markets that can encourage insurer participation and reduce premiums where states implement programs.
Hospitals, labs, ambulatory surgical centers, health plans, and vendors face large new administrative, IT, and compliance burdens to collect, standardize, and publish detailed price and payment data, likely raising operating costs that could be passed to patients, insurers, or employers and strain smaller providers.
The bill institutes coverage and enrollment restrictions — including requiring government photo ID/documentation for Exchange enrollees, prohibiting HAA funds from paying for abortion and broadly excluding 'gender transition procedures' from qualified plans, and limiting CSR payments for abortion‑covering plans — which will reduce access to reproductive and gender‑affirming care and create new en
Requiring minimum enrollee contributions and phasing down/enforcing lower income caps for enhanced credits will reduce net subsidies for many households, increasing out‑of‑pocket premiums for some low‑ and middle‑income families who previously received larger assistance.
Based on analysis of 10 sections of legislative text.
Limits federal premium tax credit amounts by requiring minimum enrollee contributions, creates Healthcare Affordability Accounts, expands §1332 waiver options, mandates hospital/ASC price transparency, and requires quarterly vendor disclosures to group plans.
Caps premium tax credit payments by requiring minimum monthly enrollee contributions and directs advance credit deposits into newly created Healthcare Affordability Accounts for certain years. It also requires government ID for Marketplace enrollees over 18, expands state flexibility under ACA §1332 to fund invisible high‑risk pools or reinsurance, strengthens hospital and ambulatory surgical center price‑transparency rules, and forces quarterly disclosures from health‑plan service providers to group health plans and issuers. The bill changes tax and ACA rules, creates new enrollment and verification duties for Exchanges, sets timelines for Treasury/HHS actions, updates state waiver guidance, broadens price transparency obligations for hospitals and ASCs, and imposes data‑reporting and anti‑confidentiality limits on third‑party health plan vendors and PBMs to improve oversight and price visibility.