# 119-s-5496: Health CARE Act of 2026 119-s-5496, Health CARE Act of 2026, is a 119th Congress bill sponsored by Sen. Warner, Mark R. [D-VA] (D-VA); status introduced; PRIA reads it as touching household money (as of 2026-10-16). - Canonical: https://policyrisk.com/legislation/119-s-5496 - As of: 2026-10-16 - Plain-text twin of the page above; the HTML and this file carry the same facts. ## Facts - Bill: 119-s-5496 - Congress: 119 - Title: Health CARE Act of 2026 - Status: introduced - Introduced: 2026-09-24 - Sponsor: Sen. Warner, Mark R. [D-VA] (D-VA) - Cosponsors: 0 - Policy area: Health - Touches household money: yes - Last recorded action: 2026-10-16 ## Summary **Affordability across insurance and drug prices** is the core goal of the Health CARE Act of 2026, which pairs permanent affordability fixes with sweeping price transparency, Medicaid stabilizers, and Medicare benefit expansions. - Families and consumers get stronger cost protections. The bill permanently extends enhanced premium tax credits, sets annual out‑of‑pocket caps for essential health benefits with a $2,000 prescription drug cap for self‑only plans in 2028, and limits insulin cost sharing to the lesser of $35 per 30‑day supply or 25 percent of the negotiated price. - States and Medicaid programs gain new stability tools. The Act restructures enhanced expansion funding rules and creates an economic‑downturn FMAP boost that uses state unemployment increases multiplied by 4.8, capped so no FMAP quarter exceeds 95 percent. - Providers, insurers, and drugmakers face new price rules and data requirements. Federal drug price negotiation expands and a negotiated “maximum fair price” can apply to private plans. Plans, hospitals, labs, and pharmacies must publish machine‑readable rates and face civil penalties for noncompliance, with hospital penalties ranging from about $300 per day up to persistent noncompliance caps totaling as high as $10 million. ## Provisions PRIA read - Lower drug bills and insulin caps: benefit, high. If enacted, group and individual plans would have new annual out-of-pocket limits for plan years starting January 1, 2028. The self-only prescription drug cap would be $2,000 in plan year 2028 and would be indexed later; other-than-self-only caps would equal twice the self-only amount. For covered… - Medicare access, hearing, and drug talks: benefit, high. If enacted, Medicare would cover certain hearing tests and hearing aids starting January 1, 2028 for people with moderately severe or worse hearing loss. Medicare would pay for one hearing aid per ear every five years and require a written order. Medicare Advantage plans would face new prior-author… - Stronger price and billing transparency: benefit, medium. If enacted, plans and providers would have to give clearer cost information to people. Group plans would send detailed explanations of benefits within 45 days after a claim decision. Providers would have to tell patients how to request an itemized bill and provide itemized protected health informat… - Low-cost individual plan and navigator help: benefit, medium. If enacted, HHS would offer a coordinated low-cost health plan in the individual market starting in plan year 2028. The plan’s options could not cost more than comparable Exchange options, and the Secretary would set competitive provider payment rates with special attention to rural and underserved… - Medicaid funding boosts and sequencing: benefit, medium. If enacted, States with qualifying unemployment increases would get a higher federal Medicaid matching rate for fiscal quarters starting January 1, 2026. The FMAP boost would equal the State’s excess unemployment percentage points times 4.8, rounded to the nearest tenth, and no FMAP under this rule… - Repeal and rescission of recent health items: cost, medium. If enacted, the bill would repeal most of subtitle B of title VII of Public Law 119-21 while keeping a few named sections. It would also rescind unobligated amounts appropriated under the repealed provisions, including a listed Social Security Act subsection. The text does not state the dollar amou… - Drug-pricing, PBM, and pharmacy rules: mixed, medium. If enacted, the bill would tighten rules for pharmacy benefit managers and make state Medicaid drug contracts use pass-through pricing for covered outpatient drugs starting 18 months after enactment. The government would run monthly national surveys of pharmacy acquisition prices and publish benchm… ## Related bills - 119-s-3990: PrEP Access and Coverage Act of 2026 - 119-s-2763: Keep Billionaires Out of Social Security Act - 119-s-51: Washington, D.C. Admission Act - 119-s-5108: Right to IVF Act of 2026 - 119-s-2982: Federal Employees Civil Relief Act - 119-s-1503: Equality Act ## Sources - [119-s-5496 on Congress.gov](https://www.congress.gov/bill/119th-congress/senate-bill/5496) ## Related - [119-s-3990: PrEP Access and Coverage Act of 2026](https://policyrisk.com/legislation/119-s-3990) - [119-s-2763: Keep Billionaires Out of Social Security Act](https://policyrisk.com/legislation/119-s-2763) - [119-s-51: Washington, D.C. Admission Act](https://policyrisk.com/legislation/119-s-51) - [119-s-5108: Right to IVF Act of 2026](https://policyrisk.com/legislation/119-s-5108) - [119-s-2982: Federal Employees Civil Relief Act](https://policyrisk.com/legislation/119-s-2982) - [119-s-1503: Equality Act](https://policyrisk.com/legislation/119-s-1503) - [All bills in Congress](https://policyrisk.com/legislation) Source: PRIA, https://policyrisk.com/legislation/119-s-5496 (as of 2026-10-16).