Health Care Fairness for All Act
Sponsored By: Representative Sessions
Introduced
Summary
Repeal of the individual and employer coverage mandates would remove federal forcing of who must have health insurance and replace major parts of the current system with new tax credits, HSA rules, and State-driven payment changes. The bill focuses on shifting payment tools rather than keeping the old coverage mandates in place.
Show full summary
- Families and individuals would get a new monthly Health Insurance Tax Benefit (new IRC §36C) for taxable years after December 31, 2025. The credit starts with a $4,000 annual base amount and adds $2,000 per qualifying child and can be paid in advance with year-end reconciliation.
- Employers and workers would no longer face the employer coverage mandate or related reporting, and employer health reimbursement arrangements that pay individual premiums would not count as group health plans for many federal rules.
- States, plus Medicaid and Medicare stakeholders, would gain big new options. Medicaid financing shifts to a per-beneficiary §1903A formula with a national-average transition corridor and a statutory minimum Federal share of 75 percent, while Medicare provisions push site-neutral payments and extend hospital-at-home flexibilities.
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Bill Overview
Analyzed Economic Effects
13 provisions identified: 3 benefits, 1 costs, 9 mixed.
Hospital price transparency would be law
The existing federal hospital price‑transparency rule would be written into law. Hospitals would have to post standard charges so patients can see prices more easily.
Medical expense tax deduction ends
For tax years after 2025, you could no longer deduct most medical expenses if you itemize. Premiums for qualified long‑term care insurance would still be deductible.
New health insurance credit for families
Starting in 2026, you could get a refundable health credit: $4,000 a year for you (double if both spouses qualify), plus $2,000 per covered child. Each month’s credit would be capped by your HSA deposits plus your insurance premiums for that month. You could choose advance payments, with year‑end reconciliation and repayment limits for many households under 400% of poverty. But you would not qualify for this credit (or the 36B marketplace credit) unless your State Exchange offers basic health insurance in every area.
Medicaid limited above poverty; private plan option
States could not use federal Medicaid funds for most people over 100% of the poverty line, with exceptions for some pregnant women, children, and people already continuously enrolled. Spend‑down rules would apply. Some beneficiaries could choose a private plan that qualifies for the new credit instead of regular Medicaid. If the credit exceeds the plan’s cost, the state would put the extra into the person’s HSA.
New Medicaid funding formula and state share
Medicaid payments to states would follow a new formula starting July 1, 2022. Each quarter, states would get an amount based on beneficiaries, plus possible quality bonuses. States would owe a non‑federal share using a set ratio, with a federal share floor of 75% or the state’s FMAP if higher. States would face new reporting and audits, including managed care medical loss ratios.
Site-neutral hospital billing and new IDs
Starting January 1, 2026, HHS could promote more site‑neutral payments and redefine off‑campus hospital sites. Each off‑campus outpatient department would need its own provider ID by January 1, 2026. HHS could not deny outpatient status just because a service may be safe only as inpatient. Limits on physician‑owned hospitals would be rolled back to pre‑ACA rules. These steps could change billing and some out‑of‑pocket costs.
More short-term and limited health plans
Short‑term plans would follow the 2018 federal definition, making them easier to sell. The Secretary would set yearly payout caps for limited‑benefit plans; after you hit the cap, some of your property would be protected from seizure for new medical bills. Direct primary care subscriptions would not be treated as insurance under several federal laws. States could promote more plans outside their Exchanges, including through association plans and high‑risk pools.
No mandate, late penalties, 5:1 pricing
The federal individual mandate would end for months after December 2024. If you enroll after gaps, your premium could rise by 20% for each full year you were uninsured, for a limited time. States could allow adult premiums to vary by age up to 5‑to‑1. All individual‑market insurers would have to join a risk‑adjustment program. The bill would also return much of federal health law to its pre‑ACA form while keeping core protections like no pre‑existing‑condition exclusions and coverage for dependents to 26.
Employer coverage mandate repealed and reporting eased
Employers would no longer face the federal coverage mandate or its reporting after the first month that starts 30+ days post‑enactment. Health premium details would also be removed from W‑2s for years after 2018. Employers could reimburse workers for individual plan premiums without creating a group health plan under many federal laws. Employees could lose some group‑plan protections when employers use reimbursements.
Medicare telehealth and hospital-at-home stay
Medicare telehealth flexibilities would continue after the emergency period and after December 1, 2026. Medicare patients could get hospital‑level care at home, including telehealth and virtual 24‑hour nursing. HHS would issue health and safety rules for these programs within 12 months.
Grants to treat uninsured tied to credits
The government would set aside each year 25% of the unused capacity of the new health credits and give that money to states. States could use the grants to help uninsured people get services or to increase certain hospital payments. Calculations would start with 2026; grant amounts could be estimated and later reconciled.
Roth HSAs and tougher HSA rules
Starting in 2026, you could open a Roth HSA. You could put in $5,000 a year ($1,000 more if 55+). Contributions would not be deductible, but qualified withdrawals would be tax‑free, and prepaid doctor subscriptions could be covered. A last‑month rule would allow full‑year contributions if you are eligible in December, but you would owe tax plus a 10% charge if you fail the 12‑month testing period (except for death or disability). If you inherit an HSA, you would be treated as the account beneficiary for HSA rules.
States could manage Medicare for duals
A state could choose to receive the Medicare payments for people who have both full Medicaid and Medicare, starting with quarters on or after July 1, 2022. The state would have to provide the Medicare items and services and pay providers at least Medicare rates. Medicare would stop paying providers directly for those individuals and send the money to the state instead.
Sponsors & CoSponsors
Sponsor
Sessions
TX • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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