Sponsors (6)
The bill increases state flexibility, moves federal subsidies into individual THFA accounts, expands small‑employer tax credits, and boosts price transparency to give consumers and states more choices, but does so at the risk of higher out‑of‑pocket costs for vulnerable people, weaker nationwide consumer protections, restricted access to certain reproductive and gender‑affirming care, and fiscal and administrative trade‑offs.
Low- and moderate-income residents in waiver States receive the full value of premium tax credits and cost-sharing reductions deposited into individual Trump Health Freedom Accounts (THFAs), giving them direct, usable funds for coverage.
States can tailor insurance rules (operate State Exchanges or permit private commercial sales) and apply through a consolidated waiver process, giving state governments more local control and reducing administrative burden.
Small employers in §1335 waiver States get a larger, longer-lasting small-group tax credit (up to 50% of qualified expenses, 35% for tax‑exempt employers), lowering employer healthcare 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.
Redirecting federal premium tax credits and CSRs into individual accounts could weaken premium stabilization and risk pooling, potentially raising premiums for some consumers and shifting costs onto taxpayers.
Changing subsidy calculations to a national average silver premium may reduce effective subsidies for residents in higher-premium States, leaving them with smaller assistance relative to local costs.
Based on analysis of 5 sections of legislative text.
Allows States to waive key ACA rules and redirects federal premium tax credits/CSRs into individual 'Trump Health Freedom Accounts', creates related HSA and tax‑credit changes, and updates price‑transparency rules.
Introduced December 9, 2025 by August Pfluger · Last progress December 9, 2025
Creates a new federal waiver pathway that would let States opt out of major Affordable Care Act requirements and have the federal premium tax credits and cost‑sharing reductions redirected into individual ‘‘Trump Health Freedom Accounts’’ for residents of participating States. Establishes special rules for those accounts (treated as a unique category of health savings account with restrictions on uses), raises a small‑employer tax credit for employers in waiver States, and orders HHS/Treasury/Labor to tighten and standardize price‑transparency rules for hospitals and health plans within 90 days.