Sponsors (3)
Introduced December 9, 2025 by Andrew S. Biggs · Last progress December 9, 2025
The bill expands options and tax-preferred savings for employers and some consumers while tightening subsidy rules and restricting coverage for abortion and gender-transition care — trading broader market flexibility and taxpayer savings for higher financial risk and reduced access to certain care for low-income, female, and transgender people.
Small-business owners and their employees can join association/CHOICE plans and (for employers) receive temporary tax credits, expanding access to employer-style coverage and potentially lowering premium and administrative costs.
In States that obtain waivers, people who would otherwise receive premium tax credits can get deposits into personal health accounts to spend on coverage, giving enrollees direct control over subsidy dollars.
A federal reinsurance program (annual appropriations capped at $6B) may lower individual-market premiums by reimbursing high-cost claims, reducing premiums for some enrollees.
Low-income people and marketplace enrollees face a high risk of losing effective subsidy protection—replacing direct premium tax credits with account deposits in waiver States or tightening advance credit rules can leave them exposed to premium volatility and higher out-of-pocket costs.
Prohibiting federal subsidies and account funds from covering abortion and banning federal funding for gender-transition procedures will reduce affordable access to abortion and transgender medical care, increasing out-of-pocket costs or denying care for women and transgender people.
Expanded association/alternative plan rules, employer-level rating, and ERISA preemption risk fragmenting risk pools and limiting state consumer protections, which can raise premiums for marketplace enrollees and reduce state oversight.
Based on analysis of 9 sections of legislative text.
Allows states to waive core ACA protections and convert premium tax credits into individual accounts, expands association health plans, mandates provider price disclosures, and bars most federal funding for abortion coverage.
Creates a broad set of changes to how individual and employer health coverage works: it lets States apply for waivers to set aside many ACA rules and redirects premium tax credits into individual accounts, expands rules for association health plans under ERISA, requires providers to disclose when a patient’s cost‑sharing would exceed a cash/self-pay price (with a private right of action), tightens Exchange open‑enrollment and special‑enrollment rules, and bars use of federal funds (including tax credits) to pay for most abortion coverage. Several provisions take effect January 1, 2026 or in plan years beginning in 2027, while some funding and coverage restrictions apply on enactment.