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Allows States to opt out of many Affordable Care Act rules and certain tax provisions for plan years beginning in 2026 if they create and maintain a high‑risk pool or equivalent program, and creates a new HSA‑like account (Trump Health Freedom Account) to receive redirected premium supports for eligible residents. It also expands the small‑employer health insurance tax credit for employers in waiver States and requires HHS, Treasury, and Labor to tighten and standardize hospital and plan price‑and‑outcomes transparency rules promptly after enactment.
The bill expands state flexibility, cash-based subsidy alternatives, and employer tax incentives to increase plan choice and employer coverage, but concentrates benefits in waiver States while risking weaker consumer protections, restricted coverage for reproductive and gender-affirming care, unequal access across states, fiscal cost, and added compliance burdens for providers.
Low- and moderate-income residents in States that receive §1335 waivers can get cash deposits into Trump Health Freedom Accounts (THFAs) equal to the premium tax credit and CSR amounts, paid monthly/quarterly/annually, giving them immediate purchasing power and more flexible ways to buy coverage.
States with approved waivers can tailor insurance rules, operate private commercial platforms or State Exchanges, permit interstate sale of state‑authorized plans, and allow child-only plans, expanding plan choices and state-level flexibility.
Small employers in waiver States can claim larger and longer-lasting small-employer tax credits (up to 50% of premiums; 35% for tax-exempt employers), with relaxed eligibility rules so more firms qualify, lowering employer costs and encouraging employer-sponsored coverage.
Low-income and uninsured residents in waiver States may face weaker consumer protections and higher premiums if broad ACA market rules are waived, reducing affordability and financial protection.
Replacing Exchange-based premium tax credits and CSRs with fixed THFA payments risks undercompensating people (payments may not cover plan costs), causing loss of affordable coverage or higher out-of-pocket spending for subsidy recipients in waiver States.
THFA rules bar use of funds for abortion (with limited exceptions) and for gender-affirming care, and rely on narrow biological sex definitions, which will restrict access and increase out-of-pocket costs for women and transgender people and create administrative disputes.
Introduced November 20, 2025 by Richard Lynn Scott · Last progress November 20, 2025