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119-hr-6538119th CongressWALLET

More Affordable Care Act

Sponsored By: Representative Pfluger, August [R-TX-11]

Introduced

Summary

This bill would let states redirect ACA subsidies into individual Trump Health Freedom Accounts by approving broad Health Freedom waivers. It would let waiver states skip many ACA requirements and instead deposit premium tax credits and cost-sharing amounts into new Health Savings Accounts for eligible residents.

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  • States: Would allow a Health Freedom Waiver Program that can waive multiple Affordable Care Act rules for plan years starting January 1, 2026 if a state gives at least 90 days notice and keeps an invisible high-risk pool or equivalent.
  • Individuals and families: Would channel each eligible resident’s premium tax credit and cost-sharing reduction amounts into a Trump Health Freedom Account, with payments based on the national silver benchmark and optional monthly, quarterly, or lump-sum delivery. TFHA funds could not be used for gender transition procedures or abortion services.
  • Small employers: Would set the small-employer health insurance credit at 50 percent (35 percent for certain tax-exempt employers), raise the eligible-employer threshold to 50 employees, and apply to taxable years after December 31, 2025.
  • Providers and transparency: Would require HHS, Treasury, and Labor to update rules within 90 days to disclose actual prices, standardize pricing, strengthen enforcement, and publish provider outcomes data.

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 2 benefits, 0 costs, 1 mixed.

Bigger small-business health tax credit

If enacted, this bill would raise the small-employer health credit to 50 percent for eligible employers in a waiver State. The change applies for taxable years beginning after December 31, 2025. The bill also treats certain waiver-authorized plans as qualified, raises the eligible-employer size threshold, removes some phaseout limits, and relaxes rules that previously limited tax-exempt employers. The credit is based on the employer's qualified premium contributions for the year.

Major changes to health subsidies and waivers

If enacted, this bill would let States apply for a Health Freedom Waiver to change some federal insurance rules. Waivers would start for plan years beginning January 1, 2026, and a State must notify at least 90 days before joining. A State must keep an invisible high-risk pool or similar program to limit premium risk. The Secretary could only waive rules within the Secretary's authority and must issue regulations within one year. If a State has an approved waiver, the government would also put the dollar value of your premium tax credit and cost-sharing reduction into a special health savings account called a Trump Health Freedom Account. Those amounts would be calculated using the national average silver-plan premium among non-waiver States. TFHA payments would begin for plan years starting January 1, 2026, and the accounts use new tax rules for tax years after December 31, 2025. You could get payments monthly, quarterly, or as one lump sum. TFHA money could not be used to pay premiums for plans that cover gender transition procedures or abortion services, nor to pay for those services, subject to specified exceptions. States must make plans they authorize available on Exchanges or approved commercial platforms while waivers are in effect.

Hospitals must post real prices

If enacted, HHS, Treasury, and Labor would have to update rules within 90 days to require hospitals to disclose actual prices, not estimates. The updates must make price data standardized and comparable across hospitals and plans. The agencies would also update enforcement policies to improve reporting accuracy and require public reporting of provider outcomes data. These changes aim to help people compare costs and quality.

Sponsors & CoSponsors

Sponsor

Pfluger, August [R-TX-11]

TX • R

Cosponsors

  • Rep. Bean, Aaron [R-FL-4]

    FL • R

    Sponsored 12/9/2025

  • Rep. Fedorchak, Julie [R-ND-At Large]

    ND • R

    Sponsored 12/9/2025

  • Rep. Baird, James R. [R-IN-4]

    IN • R

    Sponsored 12/9/2025

  • Rep. Clyde, Andrew S. [R-GA-9]

    GA • R

    Sponsored 12/9/2025

  • Rep. Goldman, Craig A. [R-TX-12]

    TX • R

    Sponsored 12/12/2025

  • Rep. Meuser, Daniel [R-PA-9]

    PA • R

    Sponsored 9/16/2026

Roll Call Votes

No roll call votes available for this bill.

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