Territory Health Revitalization Act

HR6494 — Territories Health Equity Act of 2025

Aligns U.S. territories with U.S. tax and federal health program rules while creating territory-specific Medicare and Medicaid financing and subsidy changes. The bill would change how hospitals are paid, expand low-income Medicare help, and set a mirror tax system for possessions. - Would create new Disproportionate Share Hospital (DSH) funding mechanisms for the five U.S. territories: Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. It revises DSH target and benchmark calculations to adjust payments to territorial hospitals. - Would provide relief from Medicare Part B late enrollment penalties for Puerto Rico and would establish automatic Part B premium and cost-sharing subsidies for eligible low-income residents in the territories. It also requires more reporting, transparency, and applies Affordable Care Act exchange rules to territories that lack functioning exchanges. - Would establish a formal mirror code tax system so residents of U.S. possessions have their income taxes determined as if the possession were the United States. Payments under that system would be treated like premium tax credit refunds and the effective date depends on when the Secretary sets up the required mechanism.

HR842 — Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act

Would expand Medicare to cover multi-cancer early detection screening tests. It defines eligible tests as certain FDA-cleared or approved genomic blood tests or comparable biological-sample tests and directs the Secretary to use the national coverage determinations process to decide when they are covered.

HR380 — Affordable Shipping for All Act

Geographic price parity for shipping. This bill would bar carriers from charging higher rates or refusing service to Alaska, Hawaii, and U.S. territories for most consumer and producer goods. - Residents of Alaska, Hawaii, Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Northern Mariana Islands would pay the same shipping rates as the contiguous 48 states and D.C. for most items valued at $10,000 or less. - Small businesses and producers sending goods to noncontiguous areas would no longer face higher shipping charges for covered goods under $10,000. - Private shipping companies and the U.S. Postal Service would be prohibited from excluding service or imposing higher prices on shipments to noncontiguous areas for the defined consumer and producer goods.

HR5241 — RTCP Revitalization Act

This bill guarantees mandatory, escalating funding from the Commodity Credit Corporation for reimbursements to geographically disadvantaged farmers and ranchers. It removes the prior contingency language and relaxes payment limits when annual funding meets application demand. - Farmers and ranchers in geographically disadvantaged areas get a steadier reimbursement stream. Annual funding rises from $10 million in FY2026 to $15 million in FY2031 and remains at or above $15 million thereafter. - The Department of Agriculture gains a dedicated funding mechanism under Section 1621 that removes the phrase making actions "subject to the availability of funds," clarifying the authority to carry out payments. - Payment caps are replaced with a rule that there is no payment limitation for a fiscal year if available funds equal or exceed applications, which can allow larger reimbursements when demand is fully funded.

HR4814 — Supplemental Security Income Equality Act

Extends Supplemental Security Income to Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa. It would also treat U.S. nationals like citizens for SSI, remove a statutory cap on territorial SSI payments, and give the Social Security Commissioner flexibility to adapt rules for each territory. - Residents and families in the four named territories would become eligible for SSI under Title XVI and the bill removes the statutory limit on total SSI payments to those territories. - U.S. nationals in those territories would be treated the same as U.S. citizens for purposes of SSI eligibility and benefits. - The Social Security Commissioner would have authority to waive or modify statutory SSI requirements to adapt the program to local needs. The changes would take effect on the first day of the first federal fiscal year that begins one year or more after enactment.

HR6472 — Territorial Student Access to Higher Education Act

In-state tuition parity for U.S. territorial residents. This bill would require public colleges and universities that receive funding under the Higher Education Act to charge residents of Guam, the Commonwealth of the Northern Mariana Islands, American Samoa, and the U.S. Virgin Islands the same in-state tuition and fees that state residents pay. - Students and families: Eligible territorial residents who are U.S. nationals would be charged the same in-state tuition as state residents at public institutions that get HEA aid. This makes public college more affordable for many students from those territories. - Public institutions: Any public institution receiving HEA assistance must comply and may not charge covered individuals higher tuition than state residents. The requirement is added as a program participation condition under section 487(a) of the Higher Education Act. - Eligibility details: A "covered individual" is defined as a resident of Guam, CNMI, American Samoa, or the U.S. Virgin Islands who is a U.S. national under federal immigration law. The change is inserted as a new Section 135A in Part C of Title I of the HEA.