Sponsors (4)
The bill aims to reduce premiums and surprise bills through federal reinsurance and greater price transparency, but does so at taxpayer expense and by imposing new administrative, legal, and financial burdens on insurers and providers—with risks of market segmentation that could raise costs for some consumers.
People buying individual-market plans — especially those with chronic conditions — will likely see lower premiums and more stable plan availability because federal reinsurance payments backstop very large claims through 2030.
Enrollees who pay qualifying out-of-network costs can have those payments count toward in‑network deductibles and out‑of‑pocket maximums, reducing surprise bills and total cost‑sharing for patients and families.
Plans must disclose clear price benchmarks (lowest in‑network recognized payment and the State 25th‑percentile charge), creating clearer price information for consumers and regulators.
Taxpayers will fund the reinsurance program (up to about $6 billion per year), increasing federal outlays without identified offsets.
Issuers can opt plans out of the broader single risk pool, which may enable risk segmentation and raise premiums for consumers left in the standard pool (particularly sicker enrollees or those who remain uninsured longer).
Providers — especially smaller practices and some hospitals — will face increased administrative, compliance, and legal exposure (including variable state‑law damages), raising operating costs and creating unpredictable liability across states.
Based on analysis of 4 sections of legislative text.
Creates a federal reinsurance program for certain individual-market plans, allows insurer opt-outs of the single risk pool, requires cost-sharing crediting and provider price disclosures, effective 2026.
Introduced March 3, 2025 by Gary James Palmer · Last progress March 3, 2025
Creates a federal reinsurance program to help lower premiums for people in individual-market plans and provides funding for calendar years 2026–2030. It lets some issuers elect to exclude certain individual-market plans from the ACA single risk pool (with operational rules set by HHS), requires plans to let enrollees count qualifying out-of-network cost-sharing toward in-network deductibles/out-of-pocket maximums, and requires providers and facilities to disclose when a patient’s cost-sharing would exceed the uninsured charge for the same service. Several provisions take effect January 1, 2026, and the reinsurance program is funded by annual Treasury appropriations (formula-based, capped at $6 billion/year) through 2030.