Putting Patients First Healthcare Freedom Act

Adds a new paragraph to 26 U.S.C. 213(d) to include amounts paid by members of health care sharing ministries (including sharing of medical expenses and administrative fees) in the definition of 'medical care' for purposes of section 213.

Makes multiple amendments to section 223 (Health savings accounts), including adding provisions creating 'Trump Health Freedom Accounts', modifying eligibility and distribution rules, allowing certain conversions/rollovers, requiring inclusion of qualified HSA distributions on W-2, and adjusting effective dates and inflation-adjustment rules. Specific subsections amended include changes to 223(b), 223(c), 223(d), 223(f), and additions at the end of section 223 for Trump Health Freedom Accounts.

Adds a new section (designated 1335) to Part 4 of subtitle D of title I of the Patient Protection and Affordable Care Act, establishing a 'Health freedom waiver program' allowing States to waive certain requirements for plan years beginning on or after January 1, 2026, subject to specified conditions and processes (notification, 'money follows the person' payments into Trump Health Freedom Accounts, coordinated waiver process, exchanges availability, and regulatory requirements).

Amends section 1302 of the Patient Protection and Affordable Care Act (42 U.S.C. 18022) to (a) update the premium adjustment percentage methodology for calendar years beginning with 2027 to the methodology published April 25, 2019, and (b) add an explicit exclusion preventing essential health benefits from including items and services furnished for a gender transition procedure for plan years beginning on or after January 1, 2027.

Amends section 1304 (42 U.S.C. 18024) by adding a new subsection defining 'gender transition procedure' and related terms for purposes of the title, listing specific surgeries, implant procedures, and medications covered by that definition.

Amends section 1311 (42 U.S.C. 18031) to change Exchange enrollment period rules: for plan years beginning on or after January 1, 2027, the open enrollment period for individual-market plans is November 1 through December 15 of the preceding calendar year, and the Secretary may not require an Exchange to provide a special enrollment period based solely on an individual's income-to-poverty relationship (except for changes in circumstances or specific events). It also adds prohibitions on certain enrollment periods and verification requirements for special enrollment periods.

Adds a new subsection (h) to section 1402 (42 U.S.C. 18071) providing appropriations language: 'such sums as may be necessary' are appropriated from the Treasury to make payments under the section for plan years beginning on or after January 1, 2027, with a limitation that appropriated amounts may not be used for payments for QHPs that include abortion coverage except in narrow exceptions.

Amends section 1411(e)(4) (42 U.S.C. 18081(e)(4)) by redesignating subparagraphs and inserting new subparagraphs that (A) require verification of income and family size when Treasury data are unavailable (disallowing sole reliance on attestation) and (B) treat certain specified income discrepancies as inconsistent and require Exchanges to take specified actions.

Amends section 1412 (42 U.S.C. 18082) to (a) add an annual filing/reconciliation requirement that may bar advance determinations if tax returns were not filed or reconciliation not completed for the relevant prior tax year, and (b) add a new subparagraph reducing advance payments for 'specified reenrolled individuals' by $5 (or higher as determined by the Secretary) for applicable months in plan years beginning on or after January 1, 2027, and defines 'applicable month' and 'specified reenrolled individual.'

Adds a new subsection (e) to 42 U.S.C. 300gg-1 permitting a health insurance issuer offering individual coverage to deny coverage to an individual who owes unpaid premiums for prior individual coverage (to the extent allowed under State law), and allowing attribution of the initial premium payment to amounts owed; defines 'controlled group' for this purpose. The amendment applies to plan years beginning on or after January 1, 2027.