All Roll Calls
Yes: 51 • No: 48
S3386119th CongressWALLET
Health Care Freedom for Patients Act of 2025
Sponsored By: Senator Crapo, Mike [R-ID]
Introduced
Summary
Creates Exchange plan HSAs and federal HSA payments for Marketplace enrollees. This bill would set up a new type of HSA tied to Exchange plans and send monthly federal payments into those accounts to lower premiums for certain enrollees.
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- Families and Marketplace enrollees: would be eligible for monthly HSA deposits in 2026 and 2027 if age 18–64 and household income is at or below 700% of the federal poverty line. Payments are $1,000 per year for ages 18–49 and $1,500 per year for ages 50–64, prorated monthly, and excluded from gross income.
- Plans and benefits: would let more lower‑premium and catastrophic plans join Exchange risk pools starting 2027 and creates appropriation authority for cost‑sharing reduction payments. CSR funds would be limited for plans that cover abortion except to save the mother’s life or in rape or incest.
- States and safety net: would offer an 80% Federal Medical Assistance Percentage to states that cover certain nonqualified aliens starting late 2027 and would bar federal matching for Medicaid and CHIP for individuals without verified citizenship or satisfactory immigration status unless a state opts to continue aid during the reasonable opportunity period.
*Provides $10.0 billion for HHS in FY 2026 and $10.0 billion in FY 2027 for the HSA contribution program and creates new appropriation authority for CSR payments, increasing federal outlays.*
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 1 benefits, 1 costs, 1 mixed.
Limits on public funding for transition care
This bill would stop federal Medicaid money from paying for many gender-transition surgeries, implants, and certain hormones. If enacted, Exchange plans would not have to treat gender-transition procedures as essential health benefits starting with plan years on or after January 1, 2027. There are narrow exceptions, for example puberty blockers for precocious puberty with parental consent and some medically necessary care for certain disorders. Households who rely on Medicaid, CHIP, or Exchange plans for transition care could face higher out-of-pocket costs or loss of coverage.
Temporary HSA payments for Exchange enrollees
This bill would create a new "Exchange plan HSA" and have HHS deposit monthly payments into those HSAs for eligible months in 2026 and 2027. You would get 1/12 of $1,000 per month if aged 18–49, or 1/12 of $1,500 per month if aged 50–64, when you are enrolled in a bronze or catastrophic Exchange plan and your household income is at or below 700% of the poverty line. The payments would not count as taxable income. The rules would also limit rollovers and disallow tax-advantaged HSA payments for most abortions and for specified sex-trait-modification services.
More low‑premium plan choices, CSR limits
This bill would let people buy more lower-premium Exchange plans by adding catastrophic enrollees to the Exchange risk pool and lifting prior limits starting with plan years on or after January 1, 2027. It would also let Congress fund cost-sharing reductions (CSR) from general Treasury appropriations for plan years beginning January 1, 2027. However, CSR payments could not be used for plans that cover abortion except in very narrow cases to save the mother's life or for rape or incest. These changes could lower premiums for some buyers while shrinking CSR support for plans that include broader abortion coverage.
Sponsors & CoSponsors
Sponsor
Crapo, Mike [R-ID]
ID • R
Cosponsors
Sen. Cassidy, Bill [R-LA]
LA • R
Sponsored 12/8/2025
Roll Call Votes
senate vote • 12/11/2025
On the Cloture Motion S. 3386
Yes: 51 • No: 48