Sponsors (3)
Official title: Establish a health freedom waiver program, to promote better price reporting and outcomes, and for other purposes.
Introduced November 20, 2025 by Richard Lynn Scott · Last progress November 20, 2025
The bill gives States and some consumers new, flexible, and tax-advantaged ways to receive and use federal health subsidies and expands plan and employer-credit options to encourage coverage, but does so by shifting subsidy structure and control to waiver programs—raising risks of higher out-of-pocket costs for vulnerable people, restricted service coverage, administrative complexity, uneven protections across States, and fiscal costs.
Low-income and uninsured residents in States that obtain §1335 waivers receive federal premium-tax-credit–equivalent payments (including deposits into tax-advantaged THFAs) and flexible payment timing, giving them immediate, cash-like funds to buy coverage or pay premiums.
State governments gain substantial flexibility to design alternative Exchange programs (e.g., high‑risk pools and THFA-based subsidy models) and to expand plan options treated as Exchange-qualified, allowing tailored local market solutions.
Small employers in waiver States (and their employees) can access larger small‑employer tax credits (up to 50% of premiums; 35% for tax‑exempt employers) and may qualify earlier, lowering employers' net cost to offer coverage and encouraging provision of employer-sponsored plans.
Low-income people and patients with high or chronic care needs could face higher effective out-of-pocket costs and reduced affordability if federal subsidies are redirected into THFA/HSA-like accounts or if state waiver plans have weaker cost-sharing protections than current ACA plans.
Women and LGBTQ+ individuals could lose coverage for abortion and most gender-affirming care because THFA funds are barred from being used for those services, increasing out-of-pocket costs and restricting access.
THFA funds are largely non‑transferable (rollovers restricted except into other THFAs), which can trap balances if people move out of waiver States or change coverage needs, reducing financial portability and flexibility.
Based on analysis of 5 sections of legislative text.
Allows states to redirect ACA premium tax credits into individual accounts (THFAs), creates THFAs with use restrictions, expands small‑employer credits, and tightens price transparency rules.
Allows states to request waivers of key Affordable Care Act and related tax requirements and redirects federal premium tax credits and cost‑sharing reductions into new individual ‘‘Trump Health Freedom Accounts’’ for residents of waiver states, effective for plan years starting Jan 1, 2026. Creates a new HSA-like account with restrictions on using funds for abortion and most gender-transition services, expands the small‑employer health insurance tax credit in waiver states, and requires updated hospital and insurer price‑transparency rules and reporting within 90 days.