Sponsors (3)
Official title: To Empower American Families with Direct Control Over Healthcare Dollars, Codify President Trump's Proven Reforms for Flexibility and Choice, Prohibit Taxpayer Funding for Abortion and Gender Transition Procedures, Eliminate Waste and Fraud in the Affordable Care Act, and Reject Extensions of Enhanced Subsidies to Insurance Companies.
Introduced December 9, 2025 by Andrew S. Biggs · Last progress December 9, 2025
The bill increases plan choice, small‑employer options, targeted supports (like reinsurance and tax‑favored accounts), and transparency, but at the cost of enabling state and plan waivers that can weaken ACA protections, redirecting subsidies into individual accounts, and imposing bans on federal funding for abortion and many gender‑affirming services — trading broader market flexibility and taxpayer‑directed funds for reduced coverage and protections for vulnerable populations.
Individual-market enrollees and uninsured people may see lower premiums because a new federal reinsurance program subsidizes very high-cost claims (90% above a high attachment point).
Small-business owners, sole proprietors, and their employees gain access to new employer-style group/association plans, a per-employee tax credit (phased down over two years), and clearer tax treatment for HRA/CHOICE reimbursements, lowering net costs and expanding small-employer options.
Enrollees in group/association and CHOICE arrangements are protected from health-status discrimination and coverage denials for preexisting conditions in those plans, preserving key consumer safeguards for many people gaining coverage through these options.
People seeking abortion care (women and pregnant people) will likely face reduced insurance coverage and higher out‑of‑pocket costs because premium tax credits, small‑business credits, grants, and other federal funds cannot subsidize plans that cover abortion, and plans that do cover abortion may be disfavored or lose other funding.
Transgender people and others who need gender‑affirming surgical or pharmaceutical care risk losing federally funded coverage and facing immediate loss of services because the bill excludes gender‑transition procedures from essential benefits and bans federal funds for defined sex‑trait modification procedures.
States can obtain waivers to opt out of key ACA market rules and redirect subsidy flows (into THFAs and state‑authorized arrangements), which risks higher premiums, less comprehensive coverage, and weaker consumer protections for many consumers if less‑regulated plans proliferate.
Based on analysis of 9 sections of legislative text.
Allows state ACA waivers with federal Health Freedom Account payments, expands association health plans, mandates provider price-disclosure, resets Exchange open enrollment, and bans taxpayer-funded abortion coverage via tax-credit limits.
Allows states to opt out of many Affordable Care Act requirements through a new "Health freedom" waiver program beginning for plan years on or after Jan 1, 2026, with federal backstop payments routed to newly described Health Freedom Accounts if tax credits would be lost. Expands rules allowing groups and associations of employers to be treated as single employers for ERISA purposes, requires provider price-disclosure to patients with a private right of action, tightens Exchange open enrollment timing, and imposes a broad ban on taxpayer funding of abortion and on using ACA tax credits for plans that cover abortion (with narrow exceptions).