Sponsors (4)
The bill aims to lower individual‑market premiums and improve price transparency by funding reinsurance and requiring disclosures, but it increases federal spending, gives insurers levers to segment risk, and imposes new compliance and litigation costs on insurers and providers that could be passed to consumers.
Individual-market enrollees (especially people with very high-cost claims, people with chronic conditions, low-income individuals) will see insurers receive federal reinsurance covering 90% of costs above $110,000 up to $300,000 in 2026, which reduces insurer risk and should help lower premiums and stabilize the individual market.
People shopping for care and coverage (middle-class families, uninsured individuals, patients with chronic conditions) will get better price information because plans must disclose rating-area lowest in-network amounts and state 25th-percentile charges and providers must notify when a consumer's cost-sharing would exceed a provider's cash price — enabling more informed decisions and potential cost
Enrollees who use lower-cost out‑of‑network providers (middle-class families, patients with chronic conditions) can have qualifying out‑of‑network charges count toward their in‑network deductible or out‑of‑pocket maximum, reducing out‑of‑pocket spending when those charges meet the program thresholds.
All U.S. taxpayers will fund the reinsurance program (up to $6 billion per year and any carryforward use), increasing federal spending without an offset provided in the section.
Individual‑market enrollees left out of insurers' chosen pools (including low‑income and other vulnerable enrollees) could face higher premiums or segmentation because issuers may limit which plans are pooled, enabling risk selection or premium‑mix shifts.
Insurers and plans will incur additional administrative and price‑verification costs to implement the new counting and disclosure rules, and those higher operating costs could be passed to enrollees through higher premiums or reduced benefits.
Based on analysis of 4 sections of legislative text.
Establishes a federal reinsurance program (2026–2030) to lower individual-market premiums, requires certain out‑of‑network charges to count toward in‑network limits, and mandates provider price disclosures with a private right of action.
Introduced March 3, 2025 by Gary James Palmer · Last progress March 3, 2025
Creates a federal reinsurance program to lower individual-market premiums by paying a portion of high-cost claims for eligible enrollees and funds that program from 2026–2030 (subject to a per-member-month formula and a $6 billion annual cap). Requires insurers to let certain out-of-network charges count toward an enrollee's in-network deductible or out-of-pocket max when those charges are at or below specific in-network or low‑percentile benchmarks, and requires providers to disclose to covered patients whether their cost‑sharing would exceed the provider’s standard charge, with a private right of action for violations. Implementation deadlines and numeric parameters for 2026 are set or delegated to the HHS Secretary.