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.
Show full summary
- 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.
View on Congress.govRelated Bills
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HR2395 — SHORT Act
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HR21 — Born-Alive Abortion Survivors Protection Act
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HR317 — Healthcare Freedom Act of 2025
Health Freedom Accounts (HFAs) would replace Health Savings Accounts across the tax code and reshape tax-advantaged health saving by expanding who can deduct contributions and what counts as medical expenses. - Families and individuals: Would raise the individual contribution limit to $12,000 and double that for joint filers, letting more money be saved tax-advantaged for health. - Older savers: Would add a $5,000 catch-up for people 55 or older, encouraging larger pre-tax health savings as they age. - Account rules and expenses: Would allow rollovers into another HFA if redeposited within 60 days and remove the monthly "eligible individual" requirement so more people can deduct contributions. Would expand qualified expenses to include direct primary care and health care sharing ministries. - Employers and workers: Would create a phased tax exclusion so employer contributions to HFAs are excluded from employee income for workers hired five years after enactment.
HR22 — SAVE Act
Requires documentary proof of U.S. citizenship to register to vote in Federal elections. The bill would add verification, recordkeeping, and new penalties while creating a sworn-affidavit and official‑verification path for people who cannot present documents. - Voters without documents: People who lack documentary proof would rely on a standardized sworn affidavit or an official verification process the Election Assistance Commission (EAC) must develop. Provisional ballots could still be cast and counted if citizenship is later verified. - State agencies and DMVs: Motor vehicle agencies and other voter registration points would be required to collect and record citizenship documents and to notify applicants in advance. The Federal mail registration form would be revised and the EAC must issue guidance within 10 days of enactment. - Removal and enforcement: States could use Department of Homeland Security Systematic Alien Verification for Entitlements (DHS SAVE), the Social Security Administration (SSA) verification service, and state ID data to identify and remove noncitizens. The bill expands private suits and increases criminal penalties for knowingly registering or assisting noncitizens.
HR4448 — Restoring Equal Opportunity Act
Prohibits disparate-impact liability under major federal civil rights laws in employment and housing. It would also nullify specific EEOC and Justice Department regulations and the Presidential approvals that adopted them. - Workers and protected groups: Individuals could not bring claims under Title VII that challenge neutral workplace policies because they produce disproportionate effects on certain groups. - Tenants and housing applicants: People could not bring disparate-impact claims under the Fair Housing Act against neutral housing practices that disproportionately affect protected classes. - Employers and housing providers: Would reduce legal exposure for neutral hiring, promotion, or housing policies that have unequal outcomes across groups. - Federal rules and enforcement: Would void identified 1966 EEOC and 1973 DOJ regulations and the Presidential approvals tied to section 602 of the Civil Rights Act, removing those rules from effect.
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