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HR8324119th CongressWALLET

Great American Healthcare Plan

Sponsored By: Representative Burlison, Eric [R-MO-7]

Introduced

Summary

Rewrites Health Savings Accounts and forces broad, machine-readable price transparency across hospitals, labs, imaging centers, and outpatient surgery centers. The bill also creates new pooled marketplaces and changes Medicare drug payment rules.

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  • Families and patients get bigger HSA flexibility. Contribution limits are replaced with a new cap linked to tax code section 402(g), a catch-up for people 50 and older, expanded qualified expenses including insurance and direct primary care, wellness reimbursements with monthly caps of $100/$150/$200, and rollovers from FSAs/HRAs.
  • People shopping for care will see detailed, machine‑readable prices. Hospitals must publish at least 300 shoppable services through 12/31/2027 and then all shoppable services. Clinical labs, imaging providers, and ambulatory surgical centers must publish standard charges and negotiated rates with uniform formats by July 1, 2028, and a real‑time consumer cost estimator is required.
  • Employers, plans, and vendors face new data and oversight rules. Health Marketplace Pools can offer group plans, ERISA contracts must give fiduciaries claims and pricing data within 15 days, and serious penalties apply for noncompliance up to $100,000 per day.

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Bill Overview

Analyzed Economic Effects

10 provisions identified: 8 benefits, 0 costs, 2 mixed.

Bigger HSA tax break and limits

If enacted, you would be able to deduct the total cash you put into your HSA for the year. The bill would also raise HSA contribution limits by tying the annual limit and the age-50 catch-up to other tax-code indexed amounts. These changes would apply to taxable years beginning after enactment.

Big new health-plan data rules

If enacted, health plans would have to file monthly machine-readable rate and payment files with public access starting by January 1, 2028. Plans must report in-network rates, drug net prices for a recent 90-day window, and billed/allowed amounts from out-of-network providers. Plan service vendors would have to give plans quarterly claims, contract, and payment data at no cost. Regulators could audit files and impose large fines for continued failures, including high daily penalties for vendors who block disclosures.

Clearer hospital, lab, and imaging prices

If enacted, hospitals, certain ambulatory surgical centers, clinical labs, and non-hospital imaging providers would have to post standardized, machine-readable price files. Posted data must show billing codes, gross charges, and discounted cash prices for recent years, and ASCs, hospitals, labs, and imaging centers would have to accept their posted discounted cash price as full payment for cash-paying patients. The health secretary must set standard formats by early 2027–2028 and can fine providers for continued noncompliance (statutory per-day caps apply). Federal price rules would not replace stronger state price-transparency laws unless a state law blocks the federal rule.

Faster itemized bills and cost estimates

If enacted, group health plans would have to give a clear, itemized notice within 45 days after any request for payment for an item or service for plan years starting January 1, 2027. Health plans would also have to provide real-time online cost and coverage estimates that accept billing codes and show expected plan payment and what you owe. If an online estimate understates your cost, the plan must hold you harmless for the difference above your responsibility. You could get the same information by phone or paper at no cost.

HSA pays primary care and wellness

If enacted, HSAs could be used to pay primary care subscription fees and certain health-sharing payments. The bill would also allow monthly wellness reimbursements from HSAs, limited by your HSA balance: $100 per month if your balance is $5,000 or less; $150 per month if your balance is over $5,000 up to $10,000; and $200 per month if your balance is over $10,000. These rules would apply to amounts paid after enactment in taxable years beginning after enactment.

More low-risk drugs in government programs

If enacted, the health secretary would make a list of low-risk 'expanded-access' prescription drugs and set protocols so trained covered individuals (for example, pharmacists and advanced practice providers) can assess and dispense them in government-sponsored programs. The secretary must finish rulemaking within 120 days after enactment. Federal rules would override conflicting state laws for those government programs unless a state passes an explicit law to prohibit it.

HSA beneficiary, correction, and bankruptcy protections

If enacted, HSAs could be rolled directly to a child, parent, or grandparent as beneficiaries. A child who gets an inherited HSA and is claimed as a dependent could treat the account as their own. The bill would allow prompt correction of administrative contribution errors if returned by the tax filing deadline and would treat HSAs like IRAs for bankruptcy exemption rules in cases filed after enactment. The bill also restructures some HSA statutory subsections.

Move FSA and charity funds to HSAs

If enacted, unused FSA or HRA balances could be moved directly into your HSA by trustee-to-trustee transfer without harming the FSA/HRA's status, and those transfers would count as HSA contributions. The bill would also let charities contribute to your HSA through a link your trustee provides; each qualifying charity could treat up to $5,000 per year in such gifts as charitable contributions for tax purposes. These changes would apply to taxable years after enactment.

New health marketplace pools for groups

If enacted, qualifying entities that form 'health marketplace pools' would be treated as an employer under ERISA for the limited purpose of offering group health plans or group insurance coverage. Pools must accept members without health-status screening and must offer coverage to all members. Pools could also offer drug-only coverage. How this affects premiums and plan choices would vary by pool structure and market behavior.

New employer rules for HSA offers

If enacted, an employer offer to put $450 a month into your HSA would count as an offer of minimum essential coverage and meet the affordability test for that month. The bill would also limit tax-free treatment of employer HSA contributions of $450 or more so the exclusion applies only for months you are enrolled. Employers would be required to make 'comparable contributions' to all comparable workers, either the same dollar amount or the same percent of the plan deductible, with pro rata rules for part-year and part-time workers.

Sponsors & CoSponsors

Sponsor

Burlison, Eric [R-MO-7]

MO • R

Cosponsors

  • Rep. Barrett, Tom [R-MI-7]

    MI • R

    Sponsored 4/16/2026

  • Rep. McClintock, Tom [R-CA-5]

    CA • R

    Sponsored 4/22/2026

  • Rep. Fuller, Clay [R-GA-14]

    GA • R

    Sponsored 4/30/2026

  • Rep. Moore, Barry [R-AL-1]

    AL • R

    Sponsored 4/30/2026

  • Rep. Mills, Cory [R-FL-7]

    FL • R

    Sponsored 4/30/2026

  • Rep. Davidson, Warren [R-OH-8]

    OH • R

    Sponsored 4/30/2026

  • Brecheen

    OK • R

    Sponsored 5/21/2026

  • Rep. Crane, Elijah [R-AZ-2]

    AZ • R

    Sponsored 6/24/2026

  • Rep. Cloud, Michael [R-TX-27]

    TX • R

    Sponsored 6/30/2026

  • Rep. Higgins, Clay [R-LA-3]

    LA • R

    Sponsored 6/30/2026

  • Rep. Biggs, Sheri [R-SC-3]

    SC • R

    Sponsored 6/30/2026

  • Rep. Downing, Troy [R-MT-2]

    MT • R

    Sponsored 7/14/2026

  • Rep. Luna, Anna Paulina [R-FL-13]

    FL • R

    Sponsored 7/22/2026

  • Rep. Boebert, Lauren [R-CO-4]

    CO • R

    Sponsored 8/31/2026

Roll Call Votes

No roll call votes available for this bill.

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