Sponsors (6)
The bill expands state flexibility, account-based subsidies, employer incentives, and price transparency to increase consumer choice and employer coverage options—but does so at the risk of weakening federal protections, creating uneven access across states, adding administrative complexity, and leaving low‑income and vulnerable people exposed to higher costs or restricted benefits.
Low- and moderate-income enrollees in States that obtain ACA section 1335 waivers will receive their premium tax credits and cost‑sharing reductions as deposits into Tax-Advantaged Trump Health Freedom Accounts (THFAs), with flexibility on payment timing and the ability to buy waiver-authorized coverage (including limited rollovers), preserving subsidy value and giving beneficiaries more control.
Small employers in waiver States (and their employees) get a substantially larger and longer-lasting small-business tax credit (up to 50% of qualifying expenses, extended beyond current phaseouts), lowering employers' net premium costs and encouraging more employer-sponsored coverage.
Patients (including Medicare and Medicaid beneficiaries) gain clearer, standardized, actual pricing and comparable data across hospitals and plans, making it easier to compare costs, reduce surprise bills, and shop for value.
Low- and moderate-income residents may face higher premiums, less comprehensive coverage, and larger out-of-pocket costs if state waivers weaken ACA protections and subsidies are calculated using a national average silver premium that is too low for local markets.
Replacing or loosening federal marketplace rules and allowing cross‑state sales under differing standards could reduce consumer protections (e.g., guaranteed issue, essential health benefits), create coverage gaps or exclusions, and enable regulatory arbitrage that harms people with preexisting or chronic conditions.
THFA rules explicitly prohibit use of funds for most abortion services and gender‑affirming transition procedures (including certain prescription and hormonal therapies), reducing access and increasing out‑of‑pocket costs for women and transgender people.
Based on analysis of 5 sections of legislative text.
Allows States to replace ACA premium tax credits with federal deposits into new THFAs, changes HSA/tax rules and small‑employer credits, and tightens price transparency rules.
Introduced December 9, 2025 by August Pfluger · Last progress December 9, 2025
Creates a federal option for States to waive many Affordable Care Act rules and replace individual premium tax credits and cost‑sharing reductions with deposited amounts into new “Trump Health Freedom Accounts” (THFAs) for residents of waiver States, available for 2026 plan/tax years. It also changes HSA rules for THFAs, expands the small‑employer health insurance tax credit in waiver States, and requires HHS (with Treasury and Labor) to strengthen price transparency and outcomes reporting within 90 days of enactment.