Sponsors (7)
The bill shifts federal subsidies and flexibility to state waiver programs and individual accounts to expand choice, employer support, and price transparency, but does so at the risk of higher out‑of‑pocket costs and weaker uniform protections for vulnerable consumers, restricted tax-advantaged access to certain care for some groups, and increased fiscal and compliance pressures.
Low- and moderate-income residents in §1335 waiver States receive premium tax credits and CSRs deposited into individual Trump Health Freedom Accounts (THFAs) and can choose payment frequency, giving them direct access to subsidy value and more flexibility paying premiums.
State governments can tailor insurance rules (operate State Exchanges or permit private commercial platforms) and benefit from a consolidated waiver-application process, allowing local policy variation and lower administrative burden for seeking federal waivers.
Small employers in §1335 waiver States can claim substantially larger and longer-lasting small-business tax credits (up to 50% of qualified expenses, 35% for tax-exempt employers) and face simplified eligibility rules, lowering employer health plan costs and encouraging offering coverage.
Low- and moderate-income residents in waiver States risk higher out-of-pocket costs and loss of standardized ACA protections if state-authorized plans reduce essential benefits, and redirecting subsidies to individual accounts plus using a national-average silver premium for calculations could weaken risk pooling and reduce effective subsidies in high-premium States, raising premiums for some.
THFA funds are barred from paying for gender-affirming care and abortion services, and the bill codifies binary biological definitions of sex in tax law, denying tax-advantaged financing for these services and creating legal/administrative conflicts for transgender individuals.
Expanding the small-employer tax credit increases federal revenue loss and could raise the deficit or force offsetting cuts or revenue-raising measures affecting all taxpayers.
Based on analysis of 5 sections of legislative text.
Allows States to waive key ACA rules, redirects premium tax credits into new individual THFAs with restricted uses, expands a small‑employer credit, and tightens price‑transparency rules.
Creates a new state waiver program that lets States opt out of key Affordable Care Act consumer protections and subsidy rules by redirecting federal premium tax credits and cost‑sharing reductions into new individual accounts called "Trump Health Freedom Accounts" (THFAs). Establishes THFAs as a special form of health savings account with limits on rollovers and an explicit ban on using THFA funds for abortion and gender‑transition procedures, expands a small‑employer health insurance tax credit for participating States, and orders HHS/Treasury/Labor to tighten hospital and plan price‑transparency rules. The changes take effect for plan and tax years beginning in 2026 and require federal agencies to update waiver application processes and regulatory guidance. The bill changes federal tax rules, Medicaid/ACA waiver practice, employer tax benefits, individual account rules, and health‑care transparency enforcement, with broad effects on state policy choices, consumers receiving subsidies, insurers, and employers in participating States.
Official title: To establish a health freedom waiver program, to promote better price reporting and outcomes, and for other purposes.
Introduced December 9, 2025 by August Pfluger · Last progress December 9, 2025