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Introduced December 9, 2025 by Andrew S. Biggs · Last progress December 9, 2025
Creates a new state-option waiver program that lets states opt out of many Affordable Care Act rules and redirect federal premium and cost-sharing support into new, HSA-like "Health Freedom Accounts," while expanding alternative group and individual coverage options (short‑term/association plans, CHOICE arrangements, expanded HRAs/HSAs) and changing exchange enrollment and verification rules. The bill also bans most federal funding for abortion and for a defined set of gender‑affirming medical or surgical procedures, requires provider price-disclosure to patients, and makes broad tax-code changes to HSAs, employer credits, and reporting. Most changes apply to plan or taxable years beginning after Dec 31, 2025, with specific exchange rules effective in 2026–2027 and regulatory deadlines within one year of enactment.
The bill expands state flexibility, tax‑advantaged savings, employer options, and some premium‑reducing programs while shifting federal subsidies into individual accounts and imposing enrollment, subsidy, and coverage restrictions that may raise costs and reduce access—especially for low‑income, older, and medically vulnerable Americans.
Low- and middle-income residents in States that accept the waiver receive direct monthly/quarterly/annual payments into personal health accounts equal to their estimated premium tax credit (and CSR), giving them cash to buy coverage or pay care.
States gain expanded flexibility to design insurance markets and use private commercial platforms or alternative Exchange approaches, which can enable more plan choice and state-level innovation.
Higher HSA contribution limits and broader HSA/FSA/HRA eligibility and rollover/reimbursement rules increase tax-advantaged savings capacity and make it easier for more people (including some seniors) to accumulate funds for medical expenses.
Low- and middle-income residents in waiver States may face higher out‑of‑pocket costs or less comprehensive coverage if state waiver plans offer fewer benefits or higher premiums than Exchange QHPs despite receiving accounts tied to national-average silver premiums.
Narrower open enrollment (Nov 1–Dec 15), bans on many income-based special enrollment periods, and required annual tax‑filing/reconciliation for advance premium tax credits could lock out or delay coverage and subsidies for low‑income people and others who need to enroll midyear.
Allowing issuers to opt certain plans out of the single risk pool, removing age‑rating limits for opt‑out plans, and expanding long-term short‑term plans can shift sick and older enrollees into smaller, more expensive pools, raising premiums and destabilizing markets for higher‑risk people.