More Affordable Care Act
Sponsored By: Representative Pfluger
Introduced
Summary
Health Freedom Waiver Program would let states opt out of key Affordable Care Act and related tax-code requirements if they run an invisible high‑risk pool or another approved risk‑mitigation program. It redirects premium tax credit and cost‑sharing amounts into new Trump Health Freedom Accounts for eligible residents.
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
6 provisions identified: 4 benefits, 1 costs, 1 mixed.
New health subsidy accounts
If enacted, the government would put into a new Trump Health Freedom Account the dollar amount equal to the premium tax credit and cost-sharing reduction you would have gotten. Payments would use the national average silver-plan premium from States without waivers. You could choose monthly, quarterly, or one lump-sum payment. You could roll other health savings accounts into it, but you generally could not move money from this account to other HSAs.
Bigger small employer tax credit
If enacted, employers in waiver States could get a larger small-employer health tax credit for taxable years after December 31, 2025. The bill would make the credit 50 percent, raise the employee-size threshold to 50, and remove the normal phaseout. Any plan authorized under the waiver rules would count as a qualified plan for the credit.
State waivers for ACA rules
If enacted, a State could get a Health Freedom Waiver for plan years starting on or after January 1, 2026. A waiver could change which federal marketplace rules and tax subsidy rules apply in that State. States that get a waiver must show they run a high-risk insurance pool or other risk-mitigation program and give 90 days' notice. Waiver States could run their own Exchange, allow private platforms, or have the federal Exchange operate but follow the State's rules about which plans can sell.
Clearer hospital and plan prices
If enacted, within 90 days HHS, Treasury, and Labor would update rules to require hospitals and plans to post actual prices, not estimates. The update would standardize price information and require public reporting of provider outcomes. Agencies would strengthen enforcement guidance or propose new rules to ensure accurate reporting.
Accounts cannot pay for certain services
If enacted, money in a Trump Health Freedom Account could not be used to pay premiums for, or to pay directly for, gender transition procedures or abortion services. The bill lists many treatments that count as gender transition procedures. It also lists narrow medical exceptions for abortion services in limited circumstances.
Child-only plans for under 21
If enacted, insurers in waiver States could sell child-only plans limited to people who are under age 21 at the start of the plan year. This would apply for plan years that begin on or after January 1, 2026. The bill does not specify whether these plans would receive federal subsidies.
Sponsors & CoSponsors
Sponsor
Pfluger
TX • R
Cosponsors
Bean (FL)
FL • R
Sponsored 12/9/2025
Fedorchak
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
Goldman (TX)
TX • R
Sponsored 12/12/2025
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov