Sponsors (3)
The bill expands state flexibility, new tax-advantaged health accounts, and employer tax credits to increase short-term affordability and consumer price transparency in participating States, but does so at the cost of fragmenting federal standards, restricting certain covered care, creating administrative and fiscal burdens, and risking higher costs or weaker protections for some patients.
Low-income and subsidy-eligible individuals in States that adopt §1335 waivers can receive cash-like payments equal to premium tax credits and cost-sharing reductions into personal, tax-advantaged accounts (monthly/quarterly/annually), increasing funds available to buy coverage or pay medical costs.
States gain substantial flexibility to design alternative Exchange/subsidy models (e.g., high‑risk pools, THFAs) and tailor plan availability, allowing local control to target subsidies and policy choices to state markets.
Small employers in waiver States can qualify for larger small-business tax credits (up to 50% of premiums; 35% for tax‑exempt employers) and may claim the credit from their first year of offering qualified plans, lowering employer costs and encouraging offering of coverage.
People who rely on subsidies could face higher out-of-pocket costs or reduced effective affordability if state-designed plans under waivers have weaker consumer protections, higher premiums, or if redirected credits are less useful for high-cost patients.
THFAs restrict covered expenses by statute (barring use for abortion services and most gender-affirming care) and limit rollovers/outflows, which can deny or increase out-of-pocket costs for affected patients and trap funds if people move or need different coverage.
Permitting plans from waiver States to be sold across participating States and limiting federal rules in waiver areas risks uneven consumer protections and competitive distortions—creating different standards and protections across States.
Based on analysis of 5 sections of legislative text.
Allows states with high‑risk pools to waive key ACA rules and redirects federal premium subsidies into new HSA‑style personal accounts, while expanding a small‑employer credit and tightening price‑transparency rules.
Introduced November 20, 2025 by Richard Lynn Scott · Last progress November 20, 2025
Creates a pathway for States that run an "invisible" high‑risk pool or similar program to opt out of major Affordable Care Act (ACA) rules and redirect the federal premium tax credits and cost‑sharing reductions that would have gone to marketplace plans into new personal health accounts. It also creates a new kind of HSA‑style account, changes the small‑employer tax credit for employers in participating States, and requires rapid updates to federal price‑transparency rules for hospitals and plans. The bill affects individual health coverage rules, tax treatment of certain health payments, employer tax incentives, and federal enforcement and disclosure of health care prices and outcomes; most changes take effect for 2026 plan or tax years or sooner for regulatory updates.