HR6512119th CongressWALLET

Putting Patients First Healthcare Freedom Act

Sponsored By: Representative Biggs (AZ)

Introduced

Summary

Creates a State waiver program that replaces premium tax credits and cost-sharing reductions with individual "Trump Health Freedom Accounts" paid into residents’ accounts. The bill also expands account-based and employer-sponsored options and blocks federal funding for abortion and certain gender-transition procedures.

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  • Families and consumers: Residents in States that get a waiver receive the premium tax credit and cost-sharing reduction amounts as deposits into Trump Health Freedom Accounts instead of traditional marketplace subsidies. Deposits use a national-average silver benchmark and can be paid monthly, quarterly, or as a lump sum.
  • Employers and workers: Employers can offer CHOICE arrangements and association plans that reimburse individual-market care up to fixed caps and pool risk. Eligible employers get a credit of $100 per enrolled employee per month in year one and half that amount in year two.
  • Patients, providers, and insurers: The bill bars federal funds from paying for abortion coverage and for defined "specified sex-trait modification procedures," while preserving life and rape/incest exceptions and requiring clear plan disclosures and abortion surcharges.

*Authorizes cost-sharing reduction payments from general Treasury funds and creates a reinsurance program funded at $50 per member-month with a hard annual cap of $6.0 billion for 2026–2030.*

Bill Overview

Analyzed Economic Effects

7 provisions identified: 3 benefits, 2 costs, 2 mixed.

Bigger HSA and flexible account rules

If enacted, HSA contribution limits would rise by $4,300 for single coverage and $8,550 for family coverage for tax years after December 31, 2025, with the increase partly phased down above $75,000 ($150,000 joint). Married spouses could split contribution limits and both count catch‑up amounts if both are age 55+. The bill would let some FSA/HRA amounts be moved into an HSA when you start a high‑deductible plan, let HSAs be treated as established if opened within 60 days of HDHP start, and allow certain health‑sharing ministry payments to count as HSA‑qualified expenses.

New CHOICE plans and association rules

If enacted, employers could offer a CHOICE arrangement that reimburses care while employees keep individual coverage or Medicare, starting for plan years after December 31, 2025. Small employers that offer CHOICE could get a business tax credit of $100 per enrolled employee per month in year one and $50 per month in year two, if not a large employer. The bill would also let qualifying associations be treated as the employer for group plans (meeting tests like 51 employees and 2 years existence) and protect stop‑loss coverage and some employer reporting rules.

Limits on federal abortion and transition funding

If enacted, federal funds could not pay for abortions or for certain gender‑transition procedures. Premium tax credits and cost‑sharing reductions would not be allowed for plans that cover abortion, except for life‑saving cases and rape or incest. Qualified health plans would have to disclose whether they cover those services and separately show any premium surcharge. Trump Health Freedom Account money would also not be allowed to pay for those services.

Reinsurance and risk‑pooling changes

If enacted, a federal reinsurance program would run 2026–2030 with funding equal to $50 per aggregate member month up to $6 billion per year. For 2026 the initial parameters would include a $110,000 attachment point, 90% payment proportion, and $300,000 per‑person cap. The bill would also let issuers elect single risk pools for certain plans and would bar Exchange QHPs from opting out of single pool treatment for plan years starting January 1, 2026. The bill defines short‑term limited duration plans and other market details.

Price transparency and out‑of‑network rules

If enacted, providers must tell patients if their cost‑sharing will exceed the cash price, starting January 1, 2026, and patients could sue for injunctive relief and state damages for failures to disclose. Plans must, at an enrollee's choice, count certain out‑of‑network provider charges toward in‑network deductibles and out‑of‑pocket maximums when the charge is no more than the plan's lowest contracted payment in the area or the State 25th‑percentile charge.

Tighter Exchange enrollment and checks

If enacted, open enrollment for plan years starting January 1, 2027 would run November 1 through December 15 of the prior year and many other open or special enrollment periods would be barred. Exchanges would be required to verify eligibility for at least 75% of Special Enrollment Period enrollments and to do extra checks if Treasury returns no income data or if your attested income is at least 10% higher than third‑party data. Exchanges could not give an automatic extra 90 days to resolve application inconsistencies for plan years starting January 1, 2027.

State waiver program for Exchanges

If enacted, states could apply for a waiver that lets them relax many ACA rules starting for plan years on or after January 1, 2026. A state must keep a program to limit high‑cost risk (for example, an invisible high‑risk pool) to get a waiver. Waivers would only change coverage rules inside the applying State and could change which plans appear on that State's Exchange.

Sponsors & CoSponsors

Sponsor

Biggs (AZ)

AZ • R

Cosponsors

  • Ogles

    TN • R

    Sponsored 12/9/2025

  • Clyde

    GA • R

    Sponsored 12/9/2025

Roll Call Votes

No roll call votes available for this bill.

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