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Creates a new federal waiver program that lets states opt out of many major Affordable Care Act (ACA) requirements if they run a state high-risk mitigation program, and redirects federal premium subsidy equivalents into new personal “Trump Health Freedom Accounts” for residents in waiver states. It also creates account rules that limit eligible uses (prohibiting payments for gender transition procedures and most abortions), changes the small-employer health insurance tax credit for employers in waiver states, and requires updated federal price-transparency and outcomes-reporting rules for providers within 90 days.
The bill shifts federal premium subsidies into individual THFAs and gives States greater flexibility and employer incentives to redesign coverage—potentially expanding plan choice and simplifying state implementation—while risking weakened consumer protections, restricted coverage for abortion and gender-affirming care, undercompensation in high-cost States, increased administrative burdens, and federal budget uncertainty.
Residents of waiver States and other individuals who would otherwise get premium tax credits or CSRs will receive those funds deposited into individual Trump Health Freedom Accounts (THFAs), and individuals may roll existing HSAs into THFAs, giving people direct, consolidated tax-advantaged funds to pay for coverage and qualified health expenses.
State governments can pursue alternative insurance models (including private commercial platforms) while retaining federal funding flows and can submit consolidated waiver applications, increasing state flexibility and reducing some administrative hurdles for implementing alternatives to standard ACA rules.
Small employers in waiver States—especially small-business owners—can receive a substantially larger and earlier tax credit for offering coverage (up to 50%, 35% for tax-exempt employers) and can qualify for the credit sooner and for more years, lowering employer costs to offer insurance.
Residents in waiver States (including uninsured people and those with chronic conditions) may lose core ACA consumer protections and face higher premiums or narrower coverage despite receiving account deposits, producing worse coverage or higher out-of-pocket costs.
People who rely on THFA funds—particularly women seeking abortion care and transgender and nonbinary people needing gender-affirming treatments—will be barred from using these accounts for abortion and many gender-affirming services, reducing access and increasing out-of-pocket costs; the bill’s detailed medical definitions also risk disputes over coverage and eligibility.
Using a national-average-based calculation to convert PTC/CSR into THFA deposits risks undercompensating people in high-cost States and makes federal subsidy amounts and overall federal costs harder to predict, potentially leaving many with larger premium burdens and creating budget uncertainty for taxpayers.
Introduced December 9, 2025 by August Pfluger · Last progress December 9, 2025