Sponsors (6)
The bill shifts federal premium subsidies and some tax-advantaged savings into individual, state‑tied accounts and gives states and small employers more flexibility and credits while increasing price transparency — trading broader federal-standard protections, portability, and certain covered care (notably abortion and gender‑affirming care) for greater state control, individualized subsidy access, and potential fiscal and market stability risks.
Low- and moderate-income residents in states that obtain §1335 waivers can have their premium tax credits and cost-sharing reductions deposited into individual Trump Health Freedom Accounts (THFAs) and consolidate savings (including some HSA-like benefits), giving them direct, flexible funds to pay premiums and medical costs and options for payment frequency.
States gain greater flexibility to design and run their own insurance markets (operate State Exchanges or allow private commercial platforms) and can use a consolidated waiver application to reduce administrative burden.
Small employers in §1335 waiver states can claim larger and longer-lasting small-business tax credits (up to 50% of qualified expenses, 35% for tax-exempt employers) and have expanded options for qualifying plans, lowering employers' net health coverage costs and simplifying credit administration.
Low- and moderate-income residents in waiver States may face higher out-of-pocket costs and weaker consumer protections if state-authorized plans reduce essential benefits or if subsidy calculations (tied to a national average silver premium) leave residents in higher-premium states with smaller effective subsidies; redirecting federal subsidies into individual accounts could also undermine risk-p
THFA rules restrict beneficiaries' access and rights: THFA deposits cannot be used for gender-affirming care or abortion, THFA holders are barred from maintaining or rolling funds into other HSAs, and deposit rules limit claiming the §223 HSA deduction — all of which reduce access to care for transgender people and people seeking abortion and limit tax benefits/portability for account holders.
Allowing plans to be sold across waiver States and commercializing exchange functions risks undermining state-level consumer protections and consistent oversight; an undefined 'invisible high‑risk pool' condition and expanded qualifying plan rules create regulatory uncertainty and complexity for regulators, employers, and administrators.
Based on analysis of 5 sections of legislative text.
Creates a new State ACA waiver that redirects federal premium subsidies into new restricted HSAs (THFAs), changes small‑employer credits, and tightens price transparency rules.
Creates a new state waiver pathway that lets States opt out of core Affordable Care Act rules starting in 2026 and redirects the federal premium tax credits and cost‑sharing reductions that would have gone to exchange enrollees into new, restricted health savings accounts called "Trump Health Freedom Accounts" (THFAs). The bill also creates more generous small‑employer tax credits in waiver States, restricts allowable uses of THFA funds (including bans on paying for gender transition procedures and abortion services), and tightens federal price‑transparency and reporting requirements for hospitals and health plans.
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