Sponsors (3)
The bill shifts federal health subsidies into individual, state‑tethered THFAs and expands state and small‑employer flexibility — which can increase consumer choice and employer coverage but risks losing federal benefit protections, weakening pooled risk‑sharing, creating coverage exclusions, and adding administrative burdens and revenue costs.
Residents in States with approved waivers receive redirected premium tax credits and cost-sharing assistance deposited into individual Trump Health Freedom Accounts (THFAs), preserving federal assistance they otherwise might lose while giving tax-advantaged savings and flexible payment timing (monthly/quarterly/lump sum).
States gain greater flexibility — a consolidated waiver application process and authority to design alternative market rules and private/commercial platforms — enabling tailored, state-level approaches to health coverage.
Small employers in waiver States (including tax-exempt organizations) can claim larger and more broadly available tax credits (up to 50% of premiums, 35% for tax-exempt), with no initial five‑year limit and relaxed size/hour thresholds, making offering employer coverage more affordable and accessible.
Residents in waiver States could lose federal consumer protections (e.g., guaranteed issue, essential health benefits) the State waives, exposing low-income people and those with chronic conditions to narrower coverage and higher out-of-pocket risk.
Redirecting premium tax credits and cost-sharing assistance into individual THFAs reduces pooled risk protections and could raise premiums or out-of-pocket costs for some enrollees, undermining risk-spreading benefits of traditional marketplaces.
THFA rules explicitly bar use of funds for certain services (notably gender-affirming care and abortion) and define transition-related procedures narrowly, likely increasing out-of-pocket costs and creating coverage disputes for women, transgender people, and others needing these services.
Based on analysis of 5 sections of legislative text.
Allows States to waive specified ACA and tax rules starting in 2026, redirects federal premium subsidies into new personal THFAs, expands small‑employer credits, and restricts THFA uses for gender‑transition and abortion services.
Introduced November 20, 2025 by Richard Lynn Scott · Last progress November 20, 2025
Creates a federal program that lets States opt out of specified Affordable Care Act and related tax requirements starting in 2026 if they notify the federal government and maintain a program to limit premium risk. When a State receives an approved waiver, the federal premium tax credits, cost‑sharing reductions, and small‑business credits that would otherwise go through the ACA marketplaces are instead directed into new individual accounts called "Trump Health Freedom Accounts" (THFAs). The bill also creates THFA rules (modeled on HSAs with limits), expands the small‑employer tax credit for employers in waiver States, and requires HHS, Treasury, and Labor to tighten price‑transparency and outcomes reporting requirements within 90 days of enactment.