Text of US HB 6512 (2025)

I 119TH CONGRESS 1ST SESSION H. R. 6512 To Empower American Families with Direct Control Over Healthcare Dollars, Codify President Trump’s Proven Reforms for Flexibility and Choice, Prohibit Taxpayer Funding for Abortion and Gender Transition Proce- dures, Eliminate Waste and Fraud in the Affordable Care Act, and Reject Extensions of Enhanced Subsidies to Insurance Companies. IN THE HOUSE OF REPRESENTATIVES DECEMBER 9, 2025 Mr. BIGGS of Arizona (for himself, Mr. OGLES, and Mr. CLYDE) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Edu- cation and Workforce, and the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such provi- sions as fall within the jurisdiction of the committee concerned A BILL To Empower American Families with Direct Control Over Healthcare Dollars, Codify President Trump’s Proven Reforms for Flexibility and Choice, Prohibit Taxpayer Funding for Abortion and Gender Transition Procedures, Eliminate Waste and Fraud in the Affordable Care Act, and Reject Extensions of Enhanced Subsidies to Insur- ance Companies. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 2 •HR 6512 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Putting Patients First 2 Healthcare Freedom Act’’ 3 SEC. 2. TABLE OF CONTENTS. 4 The table of contents of this Act is as follows: 5 Sec. 1. Short title. Sec. 2. Table of contents. TITLE I—PUTTING PATIENTS OVER HEALTH INSURANCE COMPANIES Subtitle A—More Affordable Care Act Sec. 1001. Short title. Sec. 1002. Health freedom waiver program. Sec. 1003. Trump health freedom accounts. Subtitle B—Improving HSA Access, Utility, and Flexibility Sec. 1011. Individuals entitled to part A of medicare by reason of age allowed to contribute to health savings account. Sec. 1012. Allow both spouses to make catch-up contributions to the same health savings account. Sec. 1013. FSA and HRA terminations or conversions to fund HSAs. Sec. 1014. Special rule for certain medical expenses incurred before establish- ment of health savings account. Sec. 1015. Contributions permitted if spouse has health flexible spending ar- rangement. Sec. 1016. Increase in health savings account contribution limitation for certain individuals. Sec. 1017. Health savings accounts used to purchase insurance. Subtitle C—Health Care Sharing Ministries Sec. 1018. Treatment of health care sharing ministries. Sec. 1019. Health care sharing ministry fees treated as medical care. Sec. 1020. Health care sharing ministries not treated as health insurance. TITLE II—CODIFYING TRUMP HEALTHCARE FREEDOM AGENDA Subtitle A—Association Health Plans Act Sec. 2001. Short title. Sec. 2002. Treatment of group or association of employers. Sec. 2003. Rules applicable to employee welfare benefit plans established and maintained by a group or association of employers. Sec. 2004. Rule of construction. Subtitle B—CHOICE Arrangement Act Sec. 2011. Short title. VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 3 •HR 6512 IH Sec. 2012. Treatment of health reimbursement arrangements integrated with individual market coverage. Sec. 2013. Participants in choice arrangement eligible for purchase of exchange insurance for purchase of cafeteria plan. Sec. 2014. Employer credit for choice arrangement. Subtitle C—Self-Insurance Protection Act Sec. 2021. Short title. Sec. 2022. Findings. Sec. 2023. Certain medical stop-loss insurance obtained by certain plan spon- sors of group health plans not included under the definition of health insurance coverage. Sec. 2024. Effect on other laws. Subtitle D—Small Business Flexibility Act Sec. 2031. Short title. Sec. 2032. Notification of flexible health insurance benefits. Subtitle E—Health Coverage Choice Act Sec. 2041. Short title. Sec. 2042. Definition of short-term limited duration insurance. Subtitle F—IMPACT Act of 2025 Sec. 2051. Short title. Sec. 2052. Expanding eligibility for catastrophic plans. Subtitle G—New Health Options Act Sec. 2061. Short title. Sec. 2062. Creation of a reinsurance program for a new health insurance risk pool. Sec. 2062. Promotion of high-value care. Sec. 2064. Disclosure of lower prices. Subtitle H—Fighting Waste Fraud and Abuse in the Unaffordable Care Act Sec. 2071. Short title. Sec. 2072. Addressing waste, fraud, and abuse in the ACA exchanges. Sec. 2073. Funding cost-sharing reduction payments. TITLE III—ENDING TAXPAYER FUNDING FOR ABORTION AND GENDER TRANSITION PROCEDURES Subtitle A—No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2025 Sec. 3000. Applicability to entire act. Sec. 3001. Short title. Sec. 3002. Prohibiting taxpayer funded abortions. Sec. 3003. Amendment to table of chapters. Sec. 3004. Clarifying application of prohibition to premium credits and cost- sharing reductions under aca. Sec. 3005. Revision to notice requirements regarding disclosure of extent of health plan coverage of abortion and abortion premium sur- charges. VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 4 •HR 6512 IH Subtitle B—Prohibiting Federal Funding for Gender Transition Procedures Sec. 3006. Short title. Sec. 3007. Prohibiting Federal funding for gender transition procedures. TITLE I—PUTTING PATIENTS 1 OVER HEALTH INSURANCE 2 COMPANIES 3 Subtitle A—More Affordable Care 4 Act 5 SEC. 1001. SHORT TITLE. 6 This Act may be cited as the ‘‘More Affordable Care 7 Act’’. 8 SEC. 1002. HEALTH FREEDOM WAIVER PROGRAM. 9 Part 4 of subtitle D of title I of the Patient Protec- 10 tion and Affordable Care Act (42 U.S.C. 18051 et seq.) 11 is amended by adding the following: 12 ‘‘SEC. 1335. HEALTH FREEDOM WAIVER PROGRAM. 13 ‘‘(a) IN GENERAL.— 14 ‘‘(1) WAIVER PROGRAM.—The Secretary shall 15 waive all or any requirements described in para- 16 graph (4), as determined by the applicable State, for 17 plan years beginning on or after January 1, 2026, 18 with respect to health insurance coverage within any 19 State that submits a notification under paragraph 20 (2), provided that the State maintains an invisible 21 high-risk insurance pool or another program de- 22 signed to mitigate risk to insurance premium costs. 23 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 5 •HR 6512 IH ‘‘(2) NOTIFICATION.—A State entity described 1 in paragraph (3) desiring a waiver under this section 2 for any plan year beginning on or after January 1, 3 2026, shall notify the Secretary of its intent to par- 4 ticipate in the waiver program with respect to all or 5 any requirements described in paragraph (4). Such 6 notification shall be filed at such time, not later than 7 90 days before the State intends to begin participa- 8 tion in the waiver program, and in such manner as 9 the Secretary may require, and contain such infor- 10 mation as the Secretary may require, including the 11 requirements under paragraph (4) that the State in- 12 tends to waiver and evidence that the State main- 13 tains a high-risk insurance pool. 14 ‘‘(3) STATE SUBMISSION.—A notification with 15 respect to a State may be submitted by— 16 ‘‘(A) the governor of the State; or 17 ‘‘(B) the legislature of the State, upon a 18 majority vote by the State legislature. 19 ‘‘(4) REQUIREMENTS.—The requirements de- 20 scribed in this paragraph with respect to health in- 21 surance coverage within the State are as follows: 22 ‘‘(A) Part 1 of subtitle D. 23 ‘‘(B) Part 2 of subtitle D. 24 ‘‘(C) Section 1402. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 6 •HR 6512 IH ‘‘(D) Sections 36B and 5000A of the In- 1 ternal Revenue Code of 1986. 2 ‘‘(5) MONEY FOLLOWS THE PERSON.— 3 ‘‘(A) IN GENERAL.—With respect to a 4 State waiver under paragraph (1), under which, 5 due to the structure of the State plan, individ- 6 uals and small employers in the State would not 7 qualify for the premium tax credits, cost-shar- 8 ing reductions, or small business credits under 9 sec. 36B of the Internal Revenue Code of 1986 10 or under part I of subtitle E for which they 11 would otherwise be eligible, the Secretary shall 12 provide for an alternative means by which the 13 aggregate amount of such credits or reductions 14 that would have been paid on behalf of partici- 15 pants in the Exchanges established under this 16 title had the State not received such waiver, 17 shall be paid into the Trump Health Freedom 18 Accounts established under section 223(i) of the 19 Internal Revenue Code of 1986 of eligible resi- 20 dents of the State. 21 ‘‘(B) PAYMENTS TO TRUMP HEALTH FREE- 22 DOM ACCOUNTS.—The Secretary shall pay into 23 the Trump Health Freedom Accounts of each 24 eligible resident of a State for which a waiver 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 7 •HR 6512 IH is in effect for a play year the amount equal to 1 the total amount for which the resident would 2 have been eligible in premium tax credit 3 amounts under section 36B of the Internal Rev- 4 enue Code of 1986 and cost-sharing reduction 5 amounts under section 1402 for the year, had 6 the State not had such waiver in effect. In de- 7 termining the appropriate payment amount 8 under this subparagraph, the Secretary shall 9 calculate premium tax credit amounts and cost- 10 sharing reduction amounts based on the na- 11 tional average annual premium amount for a 12 silver tier benchmark plan among States that 13 do not have such waivers in effect for the appli- 14 cable year. The Secretary shall make payments 15 into the Trump Health Freedom Accounts of el- 16 igible residents on a monthly basis, quarterly 17 basis, or in one lump sum at the beginning of 18 the year, at the option of each eligible resident. 19 ‘‘(6) COORDINATED WAIVER PROCESS.—The 20 Secretary shall develop a process for coordinating 21 and consolidating the State waiver processes applica- 22 ble under the provisions of this section, and the ex- 23 isting waiver processes applicable under section 24 1332, and titles XVIII, XIX, and XXI of the Social 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 8 •HR 6512 IH Security Act, and any other Federal law relating to 1 the provision of health care items or services. Such 2 processes shall permit a State to submit a single ap- 3 plication for a waiver under any or all of such provi- 4 sions. 5 ‘‘(7) EXCHANGES.— 6 ‘‘(A) IN GENERAL.—In the case of a State 7 in which a waiver is in effect under this section 8 for a plan year— 9 ‘‘(i) the State may— 10 ‘‘(I) operate an Exchange estab- 11 lished as described in section 1311(b); 12 or 13 ‘‘(II) allow one or more private 14 entities to run commercial platforms 15 that sell health plans approved by the 16 State insurance commissioner; or 17 ‘‘(ii) if the State does not operate an 18 Exchange as described in clause (i)(I) or 19 allow for one or more commercial plat- 20 forms described in clause (i)(II), the Sec- 21 retary shall operate a Federal Exchange, 22 as described in section 1321(c), provided 23 that any State laws regarding the avail- 24 ability of health plans on, and the oper- 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 9 •HR 6512 IH ation of, such Exchange shall apply in lieu 1 of any provision under part 1 or part 2 2 that such State has waived. 3 ‘‘(B) APPLICATION PROGRAM INTER- 4 FACE.—The Secretary shall make available to 5 any State that allows for commercial platforms 6 described in subparagraph (A)(i)(II), the appli- 7 cation program interface used for operating 8 Federal and State Exchanges, for use by any 9 private entity running such a platform under 10 State authority. 11 ‘‘(8) DEFINITIONS.—In this section: 12 ‘‘(A) ELIGIBLE RESIDENT.—The term ‘eli- 13 gible resident’ means, with respect to a State 14 for which a waiver is in effect under this sec- 15 tion, a resident who— 16 ‘‘(i) in the absence of such a waiver in 17 the State, would be eligible for a premium 18 tax credit under section 36B of the Inter- 19 nal Revenue Code of 1986 or a cost-shar- 20 ing reduction under section 1402, if the 21 resident enrolled in a qualified health plan 22 offered on the Exchange of such State; and 23 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 10 •HR 6512 IH ‘‘(ii) enrolls in a plan offered on the 1 Exchange described in paragraph (7) for 2 the applicable plan year. 3 ‘‘(B) SECRETARY.—The term ‘Secretary’ 4 means— 5 ‘‘(i) the Secretary of Health and 6 Human Services with respect to waivers re- 7 lating to the provisions described in sub- 8 paragraph (A) through (C) of paragraph 9 (4); and 10 ‘‘(ii) the Secretary of the Treasury 11 with respect to waivers relating to the pro- 12 visions described in paragraph (4)(D). 13 ‘‘(b) WAIVER PERIOD.—Each waiver under this sec- 14 tion shall be in effect beginning on January 1 of the plan 15 year for which a timely notice is submitted by the State 16 under subsection (a)(2), and continuing until the entity 17 of the State described in subparagraph (A) or (B) of sub- 18 section (a)(3) that submitted the notification under sub- 19 section (a)(2) submits to the Secretary a notification of 20 intent to discontinue participation in the waiver program 21 under this section. 22 ‘‘(c) LIMITATION.—The Secretary may not permit a 23 waiver under this section of any Federal law or require- 24 ment that is not within the authority of the Secretary. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 11 •HR 6512 IH ‘‘(d) AVAILABILITY OF PLANS.— 1 ‘‘(1) IN GENERAL.—Any health insurance cov- 2 erage offered in a State for which a waiver under 3 this section is in effect, and authorized by the insur- 4 ance commissioner of the State, shall be made avail- 5 able on, as applicable, the Federal or State Ex- 6 change or commercial platforms described in sub- 7 section (a)(7), of all States for which such a waiver 8 is in effect, subject to the laws of each such State. 9 ‘‘(2) CHILD-ONLY PLANS.—In any State for 10 which a waiver under this section is in effect, a 11 health insurance issuer may offer a plan in which 12 the only individuals eligible to enroll are individuals 13 who, as of the beginning of a plan year, have not at- 14 tained the age of 21. 15 ‘‘(e) REGULATIONS.—Not later than 1 year after the 16 date of enactment of the More Affordable Care Act, the 17 Secretary of Health and Human Services, in coordination 18 with the Secretary of the Treasury, shall promulgate regu- 19 lations to carry out this section. 20 ‘‘(f) RULE OF CONSTRUCTION REGARDING CON- 21 SUMER PROTECTIONS, INCLUDING THE PRE-EXISTING 22 CONDITION PROTECTION.—Nothing in this section shall 23 be construed to allow a State to waive the requirements 24 of title XXVII of the Public Health Service Act, including 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 12 •HR 6512 IH sections 2701, 2702, 2703, 2704, 2705, 2706, 2711, 1 2712, and 2718 of such Act.’’. 2 SEC. 1003. TRUMP HEALTH FREEDOM ACCOUNTS. 3 (a) IN GENERAL.—Section 223 of the Internal Rev- 4 enue Code of 1986 is amended by adding at the end the 5 following new subsection: 6 ‘‘(i) TRUMP HEALTH FREEDOM AC- 7 COUNTS.—For purposes of this section— 8 ‘‘(1) IN GENERAL.—In the case of a Trump 9 Health Freedom Account, this section shall be ap- 10 plied as provided in paragraphs (3) through (8). 11 ‘‘(2) TRUMP HEALTH FREEDOM ACCOUNT.— 12 The term ‘Trump Health Freedom Account’ means 13 a health savings account (determined as provided in 14 this subsection) established by or on behalf of an in- 15 dividual residing in a State for which a waiver under 16 section 1335 of the Patient Protection and Afford- 17 able Care Act is in effect which receives deposits of 18 amounts transferred to the individual pursuant to 19 section 1335(a)(5) of such Act. 20 ‘‘(3) ELIGIBLE INDIVIDUAL.—Any individual 21 covered under a health plan authorized to be made 22 available on an Exchange by section 1335(d) of such 23 Act shall be treated as an eligible individual. 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 13 •HR 6512 IH ‘‘(4) TREATMENT OF TRANSFERRED CONTRIBU- 1 TIONS.—Amounts transferred to a Trump Health 2 Freedom Account pursuant to section 1335(a)(5) of 3 such Act shall not be taken into account in deter- 4 mining the deduction allowed by subsection (a). 5 ‘‘(5) ACCOUNT MUST BE ONLY HSA OF INDI- 6 VIDUAL.— 7 ‘‘(A) IN GENERAL.—An individual who has 8 a Trump Health Freedom Account shall not be 9 treated as an eligible individual with respect to 10 any health savings account other than such 11 Trump Health Freedom Account. 12 ‘‘(B) ROLLOVER OF EXISTING ACCOUNT 13 PERMITTED.—An individual on whose behalf a 14 Trump Health Freedom Account is established 15 may roll over the balance of any other health 16 savings account of the individual to such 17 Trump Health Freedom Account according to 18 the rule of subsection (f)(5). 19 ‘‘(6) NO ROLLOVERS PERMITTED.—Except as 20 provided in paragraph (6)(B), subsection (f)(5) shall 21 not apply and no amount shall be contributed from 22 a Trump Health Freedom Account to any health 23 saving account other than a Trump Health Freedom 24 Account. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 14 •HR 6512 IH ‘‘(7) RESTRICTION ON USE OF AMOUNTS.—No 1 amounts in a Trump Health Freedom Account may 2 be used— 3 ‘‘(A) to pay premiums for a health plan 4 that covers— 5 ‘‘(i) gender transition procedures; or 6 ‘‘(ii) abortion; or 7 ‘‘(B) pay for any service described in 8 clause (i) or (ii) or subparagraph (A). 9 ‘‘(8) DEFINITIONS.—For purposes of paragraph 10 (8)— 11 ‘‘(A) GENDER TRANSITION PROCEDURE.— 12 ‘‘(i) IN GENERAL.—The term ‘gender 13 transition procedure’ means any hormonal 14 or surgical intervention for the purpose of 15 gender transition, including— 16 ‘‘(I) gonadotropin-releasing hor- 17 mone (GNRH) agonists or other pu- 18 berty-blocking or suppressing drugs to 19 stop or delay normal puberty; 20 ‘‘(II) testosterone, estrogen, pro- 21 gesterone, or other androgens to an 22 individual at doses that are super- 23 physiologic to what would normally be 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 15 •HR 6512 IH produced endogenously in a healthy 1 individual of the same age and sex; 2 ‘‘(III) castration; 3 ‘‘(IV) orchiectomy; 4 ‘‘(V) scrotoplasty; 5 ‘‘(VI) implantation of erection or 6 testicular prostheses; 7 ‘‘(VII) vasectomy; 8 ‘‘(VIII) hysterectomy; 9 ‘‘(IX) oophorectomy; 10 ‘‘(X) ovariectomy; 11 ‘‘(XI) reconstruction of the fixed 12 part of the urethra with or without a 13 metoidioplasty or a phalloplasty; 14 ‘‘(XII) metoidioplasty; 15 ‘‘(XIII) penectomy; 16 ‘‘(XIV) phalloplasty; 17 ‘‘(XV) vaginoplasty; 18 ‘‘(XVI) clitoroplasty; 19 ‘‘(XVII) vaginectomy; 20 ‘‘(XVIII) vulvoplasty; 21 ‘‘(XIX) reduction 22 thyrochondroplasty; 23 ‘‘(XX) chondrolaryngoplasty; 24 ‘‘(XXI) mastectomy; 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 16 •HR 6512 IH ‘‘(XXII) tubal ligation; 1 ‘‘(XXIII) sterilization; 2 ‘‘(XXIV) any plastic, cosmetic, or 3 aesthetic surgery that feminizes or 4 masculinizes the facial or other phys- 5 iological features of an individual; 6 ‘‘(XXV) any placement of chest 7 implants to create feminine breasts; 8 ‘‘(XXVI) any placement of fat or 9 artificial implants in the gluteal re- 10 gion; 11 ‘‘(XXVII) augmentation 12 mammoplasty; 13 ‘‘(XXVIII) liposuction; 14 ‘‘(XXIX) lipofilling; 15 ‘‘(XXX) voice surgery; 16 ‘‘(XXXI) hair reconstruction; 17 ‘‘(XXXII) pectoral implants; and 18 ‘‘(XXXIII) the removal of any 19 otherwise healthy or non-diseased 20 body part or tissue. 21 ‘‘(ii) EXCLUSIONS.—The term ‘gender 22 transition procedure’ does not include the 23 following when furnished to an individual 24 by a health care provider with the consent 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 17 •HR 6512 IH of such individual or, if applicable, such in- 1 dividual’s parents or legal guardian: 2 ‘‘(I) Services to individuals born 3 with a medically verifiable disorder of 4 sex development, including an indi- 5 vidual with external sex characteris- 6 tics that are irresolvably ambiguous 7 such as an individual born with 46 8 XX chromosomes with virilization, 9 and individual born with 46 XY chro- 10 mosomes with undervirilization, or an 11 individual born having both ovarian 12 and testicular tissue. 13 ‘‘(II) Service provided when a 14 physician has otherwise diagnosed a 15 disorder of sexual development in 16 which the physician has determined 17 through genetic or biochemical testing 18 that the individual does not have nor- 19 mal sex chromosome structure, sex 20 steroid hormone production, or sex 21 steroid hormone action for a healthy 22 individual of the same sex and age. 23 ‘‘(III) The treatment of any in- 24 fection, injury, disease, or disorder 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 18 •HR 6512 IH that has been caused by or exacer- 1 bated by the performance of gender 2 transition procedures, whether or not 3 the gender transition procedure was 4 performed in accordance with State 5 and Federal law or whether or not 6 funding for the gender transition pro- 7 cedure is permissible under this sec- 8 tion. 9 ‘‘(IV) Any procedure undertaken 10 because the individual suffers from a 11 physical disorder, physical injury, or 12 physical illness (but not mental, be- 13 havioral, or emotional distress or a 14 mental, behavioral, or emotional dis- 15 order) that would, as certified by a 16 physician, place the individual in im- 17 minent danger of death or impairment 18 of major bodily function, unless the 19 procedure is performed. 20 ‘‘(V) Puberty suppression or 21 blocking prescription drugs for the 22 purpose of normalizing puberty for a 23 minor experiencing precocious pu- 24 berty. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 19 •HR 6512 IH ‘‘(VI) Male circumcision. 1 ‘‘(B) GENDER TRANSITION.—The term 2 ‘gender transition’ means the process in which 3 an individual goes from identifying with or pre- 4 senting as his or her sex to identifying with or 5 presenting a self-proclaimed identity that does 6 not correspond with or is different from his or 7 her sex and may be accompanied with social, 8 legal, or physical changes. 9 ‘‘(C) SEX.—The term ‘sex’, when referring 10 to an individual’s sex, means to refer to either 11 male or female, as biologically determined. 12 ‘‘(D) FEMALE.—The term ‘female’, when 13 used to refer to a natural person, means an in- 14 dividual who naturally has, had, will have, or 15 would have, but for a congenital anomaly, his- 16 toric accident, or intentional or unintentional 17 disruption, the reproductive system that at 18 some point produces, transports, and utilizes 19 eggs for fertilization. 20 ‘‘(E) MALE.—The term ‘male’, when used 21 to refer to a natural person, means an indi- 22 vidual who naturally has, had, will have, or 23 would have, but for a congenital anomaly, his- 24 torical accident, or intentional or unintentional 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 20 •HR 6512 IH disruption, the reproductive system that at 1 some point produces, transports, and utilizes 2 sperm for fertilization. 3 ‘‘(b) EFFECTIVE DATE.—The amendment made by 4 this section shall apply to taxable years beginning after 5 December 31, 2025.’’. 6 Subtitle B—Improving HSA Access, 7 Utility, and Flexibility 8 SEC. 1011. INDIVIDUALS ENTITLED TO PART A OF MEDI- 9 CARE BY REASON OF AGE ALLOWED TO CON- 10 TRIBUTE TO HEALTH SAVINGS ACCOUNT. 11 (a) IN GENERAL.—Section 223(c)(1)(B) is amended 12 by striking ‘‘and’’ at the end of clause (ii), by striking 13 the period at the end of clause (iii) and inserting ‘‘, and’’, 14 and by adding at the end the following new clause: 15 ‘‘(iv) entitlement to hospital insurance 16 benefits under part A of title XVIII of the 17 Social Security Act by reason of section 18 226(a) of such Act.’’. 19 (b) TREATMENT OF HEALTH INSURANCE PUR- 20 CHASED FROM ACCOUNT.—Section 223(d)(2)(C)(iv) is 21 amended by inserting ‘‘and who is not an eligible indi- 22 vidual’’ after ‘‘who has attained the age specified in sec- 23 tion 1811 of the Social Security Act’’. 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 21 •HR 6512 IH (c) COORDINATION WITH PENALTY ON DISTRIBU- 1 TIONS NOT USED FOR QUALIFIED MEDICAL EX- 2 PENSES.—Section 223(f)(4)(C) is amended by striking 3 ‘‘Subparagraph (A)’’ and inserting ‘‘Except in the case of 4 an eligible individual, subparagraph (A)’’. 5 (d) CONFORMING AMENDMENT.—Section 223(b)(7) 6 is amended by inserting ‘‘(other than an entitlement to 7 benefits described in subsection (c)(1)(B)(iv))’’ after ‘‘So- 8 cial Security Act’’. 9 (e) EFFECTIVE DATE.—The amendments made by 10 this section shall apply to months beginning after Decem- 11 ber 31, 2025. 12 SEC. 1012. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CON- 13 TRIBUTIONS TO THE SAME HEALTH SAVINGS 14 ACCOUNT. 15 (a) IN GENERAL.—Section 223(b)(5) is amended to 16 read as follows: 17 ‘‘(5) SPECIAL RULE FOR MARRIED INDIVIDUALS 18 WITH FAMILY COVERAGE.— 19 ‘‘(A) IN GENERAL.—In the case of individ- 20 uals who are married to each other, if both 21 spouses are eligible individuals and either 22 spouse has family coverage under a high de- 23 ductible health plan as of the first day of any 24 month— 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 22 •HR 6512 IH ‘‘(i) the limitation under paragraph 1 (1) shall be applied by not taking into ac- 2 count any other high deductible health 3 plan coverage of either spouse (and if such 4 spouses both have family coverage under 5 separate high deductible health plans, only 6 one such coverage shall be taken into ac- 7 count), 8 ‘‘(ii) such limitation (after application 9 of clause (i)) shall be reduced by the ag- 10 gregate amount paid to Archer MSAs of 11 such spouses for the taxable year, and 12 ‘‘(iii) such limitation (after application 13 of clauses (i) and (ii)) shall be divided 14 equally between such spouses unless they 15 agree on a different division. 16 ‘‘(B) TREATMENT OF ADDITIONAL CON- 17 TRIBUTION AMOUNTS.—If both spouses referred 18 to in subparagraph (A) have attained age 55 19 before the close of the taxable year, the limita- 20 tion referred to in subparagraph (A)(iii) which 21 is subject to division between the spouses shall 22 include the additional contribution amounts de- 23 termined under paragraph (3) for both spouses. 24 In any other case, any additional contribution 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 23 •HR 6512 IH amount determined under paragraph (3) shall 1 not be taken into account under subparagraph 2 (A)(iii) and shall not be subject to division be- 3 tween the spouses.’’. 4 (b) EFFECTIVE DATE.—The amendments made by 5 this section shall apply to taxable years beginning after 6 December 31, 2025. 7 SEC. 1013. FSA AND HRA TERMINATIONS OR CONVERSIONS 8 TO FUND HSAS. 9 (a) IN GENERAL.—Section 106(e)(2) is amended to 10 read as follows: 11 ‘‘(2) QUALIFIED HSA DISTRIBUTION.—For pur- 12 poses of this subsection— 13 ‘‘(A) IN GENERAL.—The term ‘qualified 14 HSA distribution’ means, with respect to any 15 employee, a distribution from a health flexible 16 spending arrangement or health reimbursement 17 arrangement of such employee contributed di- 18 rectly to a health savings account of such em- 19 ployee if— 20 ‘‘(i) such distribution is made in con- 21 nection with such employee establishing 22 coverage under a high deductible health 23 plan (as defined in section 223(c)(2)) if 24 during the 4-year period preceding the 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 24 •HR 6512 IH date the employee so establishes coverage 1 the employee was not covered under such 2 a high deductible health plan, and 3 ‘‘(ii) such arrangement is described in 4 section 223(c)(1)(B)(v) with respect to any 5 portion of the plan year remaining after 6 such distribution is made, if such employee 7 remains enrolled in such arrangement. 8 ‘‘(B) DOLLAR LIMITATION.—The aggre- 9 gate amount of distributions from health flexi- 10 ble spending arrangements and health reim- 11 bursement arrangements of any employee which 12 may be treated as qualified HSA distributions 13 in connection with an establishment of coverage 14 described in subparagraph (A)(i) shall not ex- 15 ceed the dollar amount in effect under section 16 125(i)(1) (twice such amount in the case of cov- 17 erage which is described in section 18 223(b)(2)(B)).’’. 19 (b) PARTIAL REDUCTION OF LIMITATION ON DE- 20 DUCTIBLE HSA CONTRIBUTIONS.—Section 223(b)(4) is 21 amended by striking ‘‘and’’ at the end of subparagraph 22 (B), by striking the period at the end of subparagraph 23 (C) and inserting ‘‘, and’’, and by inserting after subpara- 24 graph (C) the following new subparagraph: 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 25 •HR 6512 IH ‘‘(D) so much of any qualified HSA dis- 1 tribution (as defined in section 106(e)(2)) made 2 to a health savings account of such individual 3 during the taxable year as does not exceed the 4 aggregate increases in the balance of the ar- 5 rangement from which such distribution is 6 made which occur during the portion of the 7 plan year which precedes such distribution 8 (other than any balance carried over to such 9 plan year and determined without regard to any 10 decrease in such balance during such portion of 11 the plan year).’’. 12 (c) CONVERSION TO HSA-COMPATIBLE ARRANGE- 13 MENT FOR REMAINDER OF PLAN YEAR.—Section 14 223(c)(1)(B), as amended by this preceding provisions of 15 this Act, is amended by striking ‘‘and’’ at the end of clause 16 (iii), by striking the period at the end of clause (iv) and 17 inserting ‘‘, and’’, and by adding at the end the following 18 new clause: 19 ‘‘(v) coverage under a health flexible spending ar- 20 rangement or health reimbursement arrangement for the 21 portion of the plan year after a qualified HSA distribution 22 (as defined in section 106(e)(2) determined without regard 23 to subparagraph (A)(ii) thereof) is made, if the terms of 24 such arrangement which apply for such portion of the plan 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 26 •HR 6512 IH year are such that, if such terms applied for the entire 1 plan year, then such arrangement would not be taken into 2 account under subparagraph (A)(ii) of this paragraph for 3 such plan year.’’. 4 (d) INCLUSION OF QUALIFIED HSA DISTRIBUTIONS 5 ON W–2.— 6 (1) IN GENERAL.—Section 6051(a), as amend- 7 ed by the preceding provisions of this Act, is amend- 8 ed by striking ‘‘and’’ at the end of paragraph (19), 9 by striking the period at the end of paragraph (20) 10 and inserting ‘‘, and’’, and by inserting after para- 11 graph (20) the following new paragraph: 12 ‘‘(21) the amount of any qualified HSA dis- 13 tribution (as defined in section 106(e)(2)) with re- 14 spect to such employee.’’. 15 (2) CONFORMING AMENDMENT.—Section 16 6051(a)(12) is amended by inserting ‘‘(other than 17 any qualified HSA distribution, as defined in section 18 106(e)(2))’’ before the comma at the end. 19 (e) EFFECTIVE DATE.—The amendments made by 20 this section shall apply to distributions made after Decem- 21 ber 31, 2025. 22 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 27 •HR 6512 IH SEC. 1014. SPECIAL RULE FOR CERTAIN MEDICAL EX- 1 PENSES INCURRED BEFORE ESTABLISHMENT 2 OF HEALTH SAVINGS ACCOUNT. 3 (a) IN GENERAL.—Section 223(d)(2), as amended by 4 the preceding provisions of this Act, is amended by adding 5 at the end the following new subparagraph: 6 ‘‘(F) TREATMENT OF CERTAIN MEDICAL 7 EXPENSES INCURRED BEFORE ESTABLISHMENT 8 OF ACCOUNT.—If a health savings account is 9 established during the 60-day period beginning 10 on the date that coverage of the account bene- 11 ficiary under a high deductible health plan be- 12 gins, then, solely for purposes of determining 13 whether an amount paid is used for a qualified 14 medical expense, such account shall be treated 15 as having been established on the date that 16 such coverage begins.’’. 17 (b) EFFECTIVE DATE.—The amendment made by 18 this section shall apply with respect to coverage beginning 19 after December 31, 2025. 20 SEC. 1015. CONTRIBUTIONS PERMITTED IF SPOUSE HAS 21 HEALTH FLEXIBLE SPENDING ARRANGE- 22 MENT. 23 (a) CONTRIBUTIONS PERMITTED IF SPOUSE HAS A 24 HEALTH FLEXIBLE SPENDING ARRANGEMENT.—Section 25 223(c)(1)(B), as amended by this preceding provisions of 26 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 28 •HR 6512 IH this Act, is amended by striking ‘‘and’’ at the end of clause 1 (iv), by striking the period at the end of clause (v) and 2 inserting ‘‘, and’’, and by adding at the end the following 3 new clause: 4 ‘‘(vi) coverage under a health flexible 5 spending arrangement of the spouse of the 6 individual for any plan year of such ar- 7 rangement if the aggregate reimburse- 8 ments under such arrangement for such 9 year do not exceed the aggregate expenses 10 which would be eligible for reimbursement 11 under such arrangement if such expenses 12 were determined without regard to any ex- 13 penses paid or incurred with respect to 14 such individual.’’. 15 (b) EFFECTIVE DATE.—The amendment made by 16 this section shall apply to plan years beginning after De- 17 cember 31, 2025. 18 SEC. 1016. INCREASE IN HEALTH SAVINGS ACCOUNT CON- 19 TRIBUTION LIMITATION FOR CERTAIN INDI- 20 VIDUALS. 21 (a) INCREASE.— 22 (1) IN GENERAL.—Section 223(b) is amended 23 by adding at the end the following new paragraph: 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 29 •HR 6512 IH ‘‘(9) INCREASE IN LIMITATION FOR CERTAIN 1 TAXPAYERS.— 2 ‘‘(A) IN GENERAL.—The applicable limita- 3 tion under subparagraphs (A) and (B) of para- 4 graph (2) shall be increased by $4,300 and 5 $8,550, respectively. 6 ‘‘(B) LIMITATION BASED ON MODIFIED 7 ADJUSTED GROSS INCOME.—The amount of the 8 increase under subparagraph (A) (determined 9 without regard to this subparagraph) shall be 10 reduced (but not below zero) by the amount 11 which bears the same ratio to the amount of 12 such increase (as so determined) as— 13 ‘‘(i) the excess (if any) of— 14 ‘‘(I) the taxpayer’s adjusted 15 gross income for such taxable year, 16 over 17 ‘‘(II) $75,000 ($150,000 in the 18 case of a joint return, if the eligible 19 individual has family coverage), bears 20 to 21 ‘‘(ii) $25,000 ($50,000 in the case of 22 a joint return, if the eligible individual has 23 family coverage). 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 30 •HR 6512 IH For purposes of the preceding sentence, ad- 1 justed gross income shall be determined in the 2 same manner as under section 219(g)(3)(A), 3 except determined without regard to any deduc- 4 tion allowed under this section.’’. 5 (2) ONLY TO APPLY TO EMPLOYEE CONTRIBU- 6 TIONS.—Section 106(d)(1) is amended by inserting 7 ‘‘and section 223(b)(9)’’ after ‘‘determined without 8 regard to this subsection’’. 9 (b) INFLATION ADJUSTMENT.—Section 223(g), as 10 amended by the preceding provisions of this Act, is amend- 11 ed— 12 (1) by inserting ‘‘, (b)(9)(A), (b)(9)(B)(i)(II),’’ 13 before ‘‘and (c)(2)(A)’’ each place it appears, 14 (2) by striking ‘‘clauses (ii) and (ii)’’ in para- 15 graph (1)(B)(i) and inserting ‘‘clauses (ii), (iii), and 16 (iv)’’, 17 (3) by striking ‘‘and’’ at the end of paragraph 18 (1)(B)(ii), 19 (4) by striking the period at the end of para- 20 graph (1)(B)(iii) and inserting ‘‘, and’’, and 21 (5) by inserting after paragraph (1)(B)(iii) the 22 following new clause: 23 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 31 •HR 6512 IH ‘‘(iv) in the case of the dollar amounts 1 in subsections (b)(9)(A) and 2 (b)(9)(B)(i)(II), calendar year 2025’’. 3 (c) EFFECTIVE DATE.— 4 (1) SUBSECTION (A).—The amendments made 5 by subsection (a) shall apply to taxable years begin- 6 ning after December 31, 2025. 7 (2) SUBSECTION (B).—The amendments made 8 by subsection (b) shall apply to taxable years begin- 9 ning after December 31, 2026. 10 SEC. 1017. HEALTH SAVINGS ACCOUNTS USED TO PUR- 11 CHASE INSURANCE. 12 (a) IN GENERAL.—Section 223(d)(2) of the Internal 13 Revenue Code of 1986 is amended— 14 (1) by striking subparagraphs (B) and (C), and 15 (2) by redesignating subparagraph (D) as sub- 16 paragraph (C). 17 (b) EFFECTIVE DATE.—The amendment made by 18 this section shall apply to plan years beginning after De- 19 cember 31, 2025. 20 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 32 •HR 6512 IH Subtitle C—Health Care Sharing 1 Ministries 2 SEC. 1018. TREATMENT OF HEALTH CARE SHARING MIN- 3 ISTRIES. 4 (a) INCLUSION AS MEDICAL EXPENSES.—Paragraph 5 (2) of section 223(c) of the Internal Revenue Code of 6 1986, as redesignated and amended by the preceding pro- 7 visions of this Act, is further amended by adding at the 8 end the following new subparagraph: 9 ‘‘(D) INCLUSION OF HEALTH CARE SHAR- 10 ING MINISTRIES.—The term ‘qualified medical 11 expenses’ shall include amounts paid by a mem- 12 ber of a health care sharing ministry (as de- 13 fined in section 5000A(d)(2)(B)(ii) without re- 14 gard to subclause (IV) thereof) for— 15 ‘‘(i) the sharing of medical expenses 16 among members, and 17 ‘‘(ii) administrative fees of the min- 18 istry.’’. 19 (b) EFFECTIVE DATE.—The amendments made by 20 this section shall apply to taxable years beginning after 21 the date of enactment of this Act. 22 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 33 •HR 6512 IH SEC. 1019. HEALTH CARE SHARING MINISTRY FEES TREAT- 1 ED AS MEDICAL CARE. 2 (a) IN GENERAL.—Section 213(d) of the Internal 3 Revenue Code of 1986 is amended by adding at the end 4 the following new paragraph: 5 ‘‘(12) HEALTH CARE SHARING MINISTRIES.— 6 For purposes of this section, the term ‘medical care’ 7 shall include amounts paid by a member of a health 8 care sharing ministry (as defined in section 9 5000A(d)(2)(B)(ii) without regard to subclause (IV) 10 thereof) for— 11 ‘‘(A) the sharing of medical expenses 12 among members, and 13 ‘‘(B) administrative fees of the ministry.’’. 14 (b) EFFECTIVE DATE.—The amendment made by 15 this section shall apply to taxable years beginning after 16 the date of the enactment of this Act. 17 SEC. 1020. HEALTH CARE SHARING MINISTRIES NOT 18 TREATED AS HEALTH INSURANCE. 19 (a) IN GENERAL.—Section 223(c) of the Internal 20 Revenue Code of 1986, as redesignated and amended by 21 the preceding provisions of this Act, is amended by adding 22 at the end the following new paragraph: 23 ‘‘(5) HEALTH CARE SHARING MINISTRIES NOT 24 TREATED AS HEALTH INSURANCE.—A health care 25 sharing ministry (as defined in section 26 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 34 •HR 6512 IH 5000A(d)(2)(B)(ii) without regard to subclause (IV) 1 thereof) shall not be treated as health plan or insur- 2 ance for purposes of this title.’’. 3 (b) EFFECTIVE DATE.—The amendments made by 4 this section shall apply to taxable years beginning after 5 the date of enactment of this Act. 6 TITLE II—CODIFYING TRUMP 7 HEALTHCARE FREEDOM 8 AGENDA 9 Subtitle A—Association Health 10 Plan Act 11 SEC. 2001. SHORT TITLE. 12 This Act may be cited the ‘‘Association Health Plan 13 Act’’. 14 SEC. 2002. TREATMENT OF GROUP OR ASSOCIATION OF EM- 15 PLOYERS. 16 (a) IN GENERAL.—Section 3(5) of the Employee Re- 17 tirement Income Security Act of 1974 (29 U.S.C. 18 1002(5)) is amended— 19 (1) by striking ‘‘The term’’ and inserting ‘‘(A) 20 The term’’; and 21 (2) by adding at the end the following: 22 ‘‘(B) For purposes of subparagraph (A), a 23 group or association of employers shall be treat- 24 ed as an ‘employer’, regardless of whether the 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 35 •HR 6512 IH employers composing such group or association 1 are in the same industry, trade, or profession, 2 if such group or association— 3 ‘‘(i)(I) has established and maintains 4 an employee welfare benefit plan that is a 5 group health plan (as defined in section 6 733(a)(1)); 7 ‘‘(II) provides coverage under 8 such plan to at least 51 employees 9 after all of the employees employed by 10 all of the employer members of such 11 group or association have been aggre- 12 gated and counted together as de- 13 scribed in subparagraph (D); 14 ‘‘(III) has been actively in exist- 15 ence for at least 2 years; 16 ‘‘(IV) has been formed and main- 17 tained in good faith for purposes 18 other than providing medical care (as 19 defined in section 733(a)(2)) through 20 the purchase of insurance or other- 21 wise; 22 ‘‘(V) does not condition member- 23 ship in the group or association on 24 any health status-related factor (as 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 36 •HR 6512 IH described in section 702(a)(1)) relat- 1 ing to any individual; 2 ‘‘(VI) makes coverage under such 3 plan available to all employer mem- 4 bers of such group or association re- 5 gardless of any health status-related 6 factor (as described in section 7 702(a)(1)) relating to such employer 8 members; 9 ‘‘(VII) does not provide coverage 10 under such plan to any individual 11 other than an employee of an em- 12 ployer member of such group or asso- 13 ciation; 14 ‘‘(VIII) has established a gov- 15 erning board with by-laws or other 16 similar indications of formality to 17 manage and operate such plan in both 18 form and substance, of which at least 19 75 percent of the board members shall 20 be made up of employer members of 21 such group or association partici- 22 pating in the plan that are duly elect- 23 ed by each participating employer 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 37 •HR 6512 IH member casting 1 vote during a 1 scheduled election; 2 ‘‘(IX) is not a health insurance 3 issuer (as defined in section 4 733(b)(2)), and is not owned or con- 5 trolled by such a health insurance 6 issuer or by a subsidiary or affiliate of 7 such a health insurance issuer, other 8 than to the extent such a health in- 9 surance issuer may participate in the 10 group or association as a member; 11 ‘‘(ii) is structured in good faith with 12 any set of criteria to qualify for such treat- 13 ment in any advisory opinion issued prior 14 to the date of enactment of the Association 15 Health Plans Act; or 16 ‘‘(iii) meets any other set of criteria to 17 qualify for such treatment that the Sec- 18 retary by regulation may provide. 19 ‘‘(C)(i) For purposes of subparagraph (B), 20 a self-employed individual shall be treated as— 21 ‘‘(I) an employer who may be- 22 come a member of a group or associa- 23 tion of employers; 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 38 •HR 6512 IH ‘‘(II) an employee who may par- 1 ticipate in an employee welfare benefit 2 plan established and maintained by 3 such group or association; and 4 ‘‘(III) a participant of such plan 5 subject to the eligibility determination 6 and monitoring requirements set forth 7 in clause (iii). 8 ‘‘(ii) For purposes of this subpara- 9 graph, the term ‘self-employed individual’ 10 means an individual who— 11 ‘‘(I) does not have any common 12 law employees; 13 ‘‘(II) has a bona fide ownership 14 right in a trade or business, regard- 15 less of whether such trade or business 16 is incorporated or unincorporated; 17 ‘‘(III) earns wages (as defined in 18 section 3121(a) of the Internal Rev- 19 enue Code of 1986) or self-employ- 20 ment income (as defined in section 21 1402(b) of such Code) from such 22 trade or business; and 23 ‘‘(IV) works at least 10 hours a 24 week or 40 hours per month providing 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 39 •HR 6512 IH personal services to such trade or 1 business. 2 ‘‘(iii) The board of a group or associa- 3 tion of employers shall— 4 ‘‘(I) initially determine whether 5 an individual meets the requirements 6 under clause (ii) to be considered to a 7 self-employed individual for the pur- 8 poses of being treated as an— 9 ‘‘(aa) employer member of 10 such group or association (in ac- 11 cordance with clause (i)(I)); and 12 ‘‘(bb) employee who may 13 participate in the employee wel- 14 fare benefit plan established and 15 maintained by such group or as- 16 sociation (in accordance with 17 clause (i)(II)); 18 ‘‘(II) through reasonable moni- 19 toring procedures, periodically deter- 20 mine whether the individual continues 21 to meet such requirements; and 22 ‘‘(III) if the board determines 23 that an individual no longer meets 24 such requirements, not make such 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 40 •HR 6512 IH plan coverage available to such indi- 1 vidual (or dependents thereof) for any 2 plan year following the plan year dur- 3 ing which the board makes such de- 4 termination. If, subsequent to a deter- 5 mination that an individual no longer 6 meets such requirements, such indi- 7 vidual furnishes evidence of satisfying 8 such requirements, such individual 9 (and dependents thereof) shall be eli- 10 gible to receive plan coverage. 11 ‘‘(D) For purposes of subparagraph (B), 12 all of the employees (including self-employed in- 13 dividuals) employed by all of the employer 14 members (including self-employed individuals) 15 of a group or association of employers shall 16 be— 17 ‘‘(i) treated as participants in a single 18 plan multiple employer welfare arrange- 19 ment; and 20 ‘‘(ii) aggregated and counted together 21 for purposes of any regulation of an em- 22 ployee welfare benefit plan established and 23 maintained by such group or association.’’. 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 41 •HR 6512 IH (b) DETERMINATION OF EMPLOYER OR JOINT EM- 1 PLOYER STATUS.—The provision of employee welfare ben- 2 efit plan coverage by a group or association of employers 3 shall not be construed as evidence for establishing an em- 4 ployer or joint employer relationship under any Federal 5 or State law. 6 SEC. 2003. RULES APPLICABLE TO EMPLOYEE WELFARE 7 BENEFIT PLANS ESTABLISHED AND MAIN- 8 TAINED BY A GROUP OR ASSOCIATION OF 9 EMPLOYERS. 10 Part 7 of subtitle B of title I of the Employee Retire- 11 ment Income Security Act of 1974 (29 U.S.C. 1181, et 12 seq.) is amended by adding at the end the following: 13 ‘‘SEC. 736. RULES APPLICABLE TO EMPLOYEE WELFARE 14 BENEFIT PLANS ESTABLISHED AND MAIN- 15 TAINED BY A GROUP OR ASSOCIATION OF 16 EMPLOYERS. 17 ‘‘(a) PREMIUM RATES FOR A GROUP OR ASSOCIA- 18 TION OF EMPLOYERS.— 19 ‘‘(1)(A) In the case of an employee welfare ben- 20 efit plan established and maintained by a group or 21 association of employers described in section 22 3(5)(B), such plan may, to the extent not prohibited 23 under State law— 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 42 •HR 6512 IH ‘‘(i) establish base premium rates 1 formed on an actuarially sound, modified 2 community rating methodology that con- 3 siders the pooling of all plan participant 4 claims; and 5 ‘‘(ii) utilize the specific risk profile of 6 each employer member of such group or 7 association to determine contribution rates 8 for each such employer member’s share of 9 a premium by actuarially adjusting above 10 or below the established base premium 11 rates. 12 ‘‘(B) For purposes of paragraph (1), the 13 term ‘employer member’ means— 14 ‘‘(i) an employer who is a member of 15 such group or association of employers and 16 employs at least 1 common law employee; 17 or 18 ‘‘(ii) a group made up solely of self- 19 employed individuals, within which all of 20 the self-employed individual members of 21 such group or association are aggregated 22 together as a single employer member 23 group, provided the group includes at least 24 20 self-employed individual members. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 43 •HR 6512 IH ‘‘(2) In the event a group or association is 1 made up solely of self-employed individuals (and no 2 employers with at least 1 common law employee are 3 members of such group or association), the employee 4 welfare benefit plan established by such group or as- 5 sociation shall— 6 ‘‘(A) treat all self-employed individuals 7 who are members of such group or association 8 as a single risk pool; 9 ‘‘(B) pool all plan participant claims; and 10 ‘‘(C) charge each plan participant the 11 same premium rate. 12 ‘‘(b) DISCRIMINATION AND PRE-EXISTING CONDI- 13 TION PROTECTIONS.—An employee welfare benefit plan 14 established and maintained by a group or association of 15 employers described in section 3(5)(B) shall be prohibited 16 from— 17 ‘‘(1) establishing any rule for eligibility (includ- 18 ing continued eligibility) of any individual (including 19 an employee of an employer member or a self-em- 20 ployed individual, or a dependent of such employee 21 or self-employed individual) to enroll for benefits 22 under the terms of the plan that discriminates based 23 on any health status-related factor that relates to 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 44 •HR 6512 IH such individual (consistent with the rules under sec- 1 tion 702(a)(1)); 2 ‘‘(2) requiring an individual (including an em- 3 ployee of an employer member or a self-employed in- 4 dividual, or a dependent of such employee or self- 5 employed individual), as a condition of enrollment or 6 continued enrollment under the plan, to pay a pre- 7 mium or contribution that is greater than the pre- 8 mium or contribution for a similarly situated indi- 9 vidual enrolled in the plan based on any health sta- 10 tus-related factor that relates to such individual 11 (consistent with the rules under section 702(b)(1)); 12 and 13 ‘‘(3) denying coverage under such plan on the 14 basis of a pre-existing condition (consistent with the 15 rules under section 2704 of the Public Health Serv- 16 ice Act).’’. 17 SEC. 2004. RULE OF CONSTRUCTION. 18 Nothing in this Act shall be construed to exempt a 19 group health plan which is an employee welfare benefit 20 plan offered through a group or association of employers 21 from the requirements of part 7 of subtitle B of title I 22 of the Employee Retirement Income Security Act of 1974 23 (29 U.S.C. 1181 et. seq.), including the provisions of part 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 45 •HR 6512 IH A of title XXVII of the Public Health Service Act as incor- 1 porated by reference into this Act through section 715. 2 Subtitle B—CHOICE Arrangement 3 Act 4 SEC. 2011. SHORT TITLE. 5 This Act may be cited as the ‘‘CHOICE Arrangement 6 Act’’. 7 SEC. 2012. TREATMENT OF HEALTH REIMBURSEMENT AR- 8 RANGEMENTS INTEGRATED WITH INDI- 9 VIDUAL MARKET COVERAGE. 10 (a) IN GENERAL.—Section 9815(b) is amended— 11 (1) By striking ‘‘exception Notwithstanding 12 subsection (a)’’ and inserting the following: ‘‘Excep- 13 tions.— 14 ‘‘(1) SELF-INSURED GROUP HEALTH PLANS.— 15 Notwithstanding subsection (a)’’ 16 (2) by adding at the end the following new 17 paragraph: 18 ‘‘(2) CUSTOM HEALTH OPTION AND INDIVIDUAL 19 CARE EXPENSE ARRANGEMENTS.— 20 ‘‘(A) IN GENERAL.—For purposes of this 21 subchapter, a custom health option and indi- 22 vidual care expense arrangement shall be treat- 23 ed as meeting the requirements of section 9802 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 46 •HR 6512 IH and sections 2705, 2711, 2713, and 2715 of 1 title XXVII of the Public Health Service Act. 2 ‘‘(B) CUSTOM HEALTH OPTION AND INDI- 3 VIDUAL CARE EXPENSE ARRANGEMENTS DE- 4 FINED.—For purposes of this section, the term 5 ‘custom health option and individual care ex- 6 pense arrangement’ means a health reimburse- 7 ment arrangement— 8 ‘‘(i) which is an employer-provided 9 group health plan funded solely by em- 10 ployer contributions to provide payments 11 or reimbursements for medical care subject 12 to a maximum fixed dollar amount for a 13 period, 14 ‘‘(ii) under which such payments or 15 reimbursements may only be made for 16 medical care provided during periods dur- 17 ing which the individual is covered— 18 ‘‘(I) under individual health in- 19 surance coverage (other than coverage 20 that consists solely of excepted bene- 21 fits), or 22 ‘‘(II) under part A and B of title 23 XVIII of the Social Security Act or 24 part C of such title, 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 47 •HR 6512 IH ‘‘(iii) which meets the nondiscrimina- 1 tion requirements of subparagraph (C), 2 ‘‘(iv) which meets the substantiation 3 requirements of subparagraph (D), and 4 ‘‘(v) which meets the notice require- 5 ments of subparagraph (E). 6 ‘‘(C) NONDISCRIMINATION.— 7 ‘‘(i) IN GENERAL.—An arrangement 8 meets the requirements of this subpara- 9 graph if an employer offering such ar- 10 rangement to an employee within a speci- 11 fied class of employee— 12 ‘‘(I) offers such arrangement to 13 all employees within such specified 14 class on the same terms, and 15 ‘‘(II) does not offer any other 16 group health plan (other than an ac- 17 count-based group health plan or a 18 group health plan that consists solely 19 of excepted benefits) to any employees 20 within such specified class. 21 In the case of an employer who offers a 22 group health plan provided through health 23 insurance coverage in the small group mar- 24 ket (that is subject to section 2701 of the 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 48 •HR 6512 IH Public Health Service Act) to all employees 1 within such specified class, subclause (II) 2 shall not apply to such group health plan. 3 ‘‘(ii) SPECIFIED CLASS OF EM- 4 PLOYEE.—For purposes of this subpara- 5 graph, any of the following may be des- 6 ignated as a specified class of employee: 7 ‘‘(I) Full-time employees. 8 ‘‘(II) Part-time employees. 9 ‘‘(III) Salaried employees. 10 ‘‘(IV) Non-salaried employees. 11 ‘‘(V) Employees whose primary 12 site of employment is in the same rat- 13 ing area. 14 ‘‘(VI) Employees who are in- 15 cluded in a unit of employees covered 16 under a collective bargaining agree- 17 ment to which the employer is subject 18 (determined under rules similar to the 19 rules of section 105(h)). 20 ‘‘(VII) Employees who have not 21 met a group health plan, or health in- 22 surance issuer offering group health 23 insurance coverage, waiting period re- 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 49 •HR 6512 IH quirement that satisfies section 2708 1 of the Public Health Service Act. 2 ‘‘(VIII) Seasonal employees. 3 ‘‘(IX) Employees who are non- 4 resident aliens and who receive no 5 earned income (within the meaning of 6 section 911(d)(2)) from the employer 7 which constitutes income from sources 8 within the United States (within the 9 meaning of section 861(a)(3)). 10 ‘‘(X) Such other classes of em- 11 ployees as the Secretary may des- 12 ignate. 13 An employer may designate (in such man- 14 ner as is prescribed by the Secretary) two 15 or more of the classes described in the pre- 16 ceding subclauses as the specified class of 17 employees to which the arrangement is of- 18 fered for purposes of applying this sub- 19 paragraph. 20 ‘‘(iii) SPECIAL RULE FOR NEW 21 HIRES.—An employer may designate pro- 22 spectively so much of a specified class of 23 employees as are hired after a date set by 24 the employer. Such subclass of employees 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 50 •HR 6512 IH shall be treated as the specified class for 1 purposes of applying clause (i). 2 ‘‘(iv) RULES FOR DETERMINING TYPE 3 OF EMPLOYEE.—For purposes for clause 4 (ii), any determination of full-time, part- 5 time, or seasonal employment status shall 6 be made under rules similar to the rules of 7 section 105(h) or 4980H, whichever the 8 employer elects for the plan year. Such 9 election shall apply with respect to all em- 10 ployees of the employer for the plan year. 11 ‘‘(v) PERMITTED VARIATION.—For 12 purposes of clause (i)(I), an arrangement 13 shall not fail to be treated as provided on 14 the same terms within a specified class 15 merely because the maximum dollar 16 amount of payments and reimbursements 17 which may be made under the terms of the 18 arrangement for the year with respect to 19 each employee within such class— 20 ‘‘(I) increases as additional de- 21 pendents of the employee are covered 22 under the arrangement, and 23 ‘‘(II) increases with respect to a 24 participant as the age of the partici- 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 51 •HR 6512 IH pant increases, but not in excess of an 1 amount equal to 300 percent of the 2 lowest maximum dollar amount with 3 respect to such a participant deter- 4 mined without regard to age. 5 ‘‘(D) SUBSTANTIATION REQUIREMENTS.— 6 An arrangement meets the requirements of this 7 subparagraph if the arrangement has reason- 8 able procedures to substantiate— 9 ‘‘(i) that the participant and any de- 10 pendents are, or will be, enrolled in cov- 11 erage described in subparagraph (B)(ii) as 12 of the beginning of the plan year of the ar- 13 rangement (or as of the beginning of cov- 14 erage under the arrangement in the case of 15 an employee who first becomes eligible to 16 participate in the arrangement after the 17 date notice is given with respect to the 18 plan under subparagraph (E) (determined 19 without regard to clause (iii) thereof)), and 20 ‘‘(ii) any requests made for payment 21 or reimbursement of medical care under 22 the arrangement and that the participant 23 and any dependents remain so enrolled. 24 ‘‘(E) NOTICE.— 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 52 •HR 6512 IH ‘‘(i) IN GENERAL.—Except as pro- 1 vided in clause (iii), an arrangement meets 2 the requirements of this subparagraph if, 3 under the arrangement, each employee eli- 4 gible to participate is, not later than 60 5 days before the beginning of the plan year, 6 given written notice of the employee’s 7 rights and obligations under the arrange- 8 ment which— 9 ‘‘(I) is sufficiently accurate and 10 comprehensive to apprise the employee 11 of such rights and obligations, and 12 ‘‘(II) is written in a manner cal- 13 culated to be understood by the aver- 14 age employee eligible to participate. 15 ‘‘(ii) NOTICE REQUIREMENTS.—Such 16 notice shall include such information as the 17 Secretary may by regulation prescribe. 18 ‘‘(iii) NOTICE DEADLINE FOR CER- 19 TAIN EMPLOYEES.—In the case of an em- 20 ployee— 21 ‘‘(I) who first becomes eligible to 22 participate in the arrangement after 23 the date notice is given with respect 24 to the plan under clause (i) (deter- 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 53 •HR 6512 IH mined without regard to this clause), 1 or 2 ‘‘(II) whose employer is first es- 3 tablished fewer than 120 days before 4 the beginning of the first plan year of 5 the arrangement, 6 the requirements of this subparagraph 7 shall be treated as met if the notice re- 8 quired under clause (i) is provided not 9 later than the date the arrangement may 10 take effect with respect to such em- 11 ployee.’’. 12 (b) INCLUSION OF CHOICE ARRANGEMENT PER- 13 MITTED BENEFITS ON W–2.— 14 (1) IN GENERAL.—Section 6051(a), as amend- 15 ed by the preceding provisions of this Act, is amend- 16 ed by striking ‘‘and’’ at the end of paragraph (18), 17 by striking the period at the end of paragraph (19) 18 and inserting ‘‘, and’’, and by inserting after para- 19 graph (19) the following new paragraph: 20 ‘‘(20) the total amount of permitted benefits for 21 enrolled individuals under a custom health option 22 and individual care expense arrangement (as defined 23 in section 9815(b)(2)) with respect to such em- 24 ployee.’’. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 54 •HR 6512 IH (c) TREATMENT OF CURRENT RULES RELATING TO 1 CERTAIN ARRANGEMENTS.— 2 (1) NO INFERENCE.—To the extent not incon- 3 sistent with the amendments made by this section— 4 (A) no inference shall be made from such 5 amendments with respect to the rules pre- 6 scribed in the Federal Register on June 20, 7 2019 (84 Fed. Reg. 28888), relating to health 8 reimbursement arrangements and other ac- 9 count-based group health plans, and 10 (B) any reference to custom health option 11 and individual care expense arrangements shall 12 for purposes of such rules be treated as includ- 13 ing a reference to individual coverage health re- 14 imbursement arrangements. 15 (2) OTHER CONFORMING OF RULES.—The Sec- 16 retary of the Treasury, the Secretary of Health and 17 Human Services, and the Secretary of Labor shall 18 modify such rules as may be necessary to conform 19 to the amendments made by this section. 20 (d) EFFECTIVE DATE.—The amendments made by 21 this section shall apply to plan years beginning after De- 22 cember 31, 2025. 23 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 55 •HR 6512 IH SEC. 2013. PARTICIPANTS IN CHOICE ARRANGEMENT ELI- 1 GIBLE FOR PURCHASE OF EXCHANGE INSUR- 2 ANCE FOR PURCHASE OF CAFETERIA PLAN. 3 (a) IN GENERAL.—Section 125(f)(3) is amended by 4 adding at the end the following new subparagraph: 5 ‘‘(C) EXCEPTION FOR PARTICIPANTS IN 6 CHOICE ARRANGEMENT.—Subparagraph (A) 7 shall not apply in the case of an employee par- 8 ticipating in a custom health option and indi- 9 vidual care expense arrangement (within the 10 meaning of section 9815(b)(2)) offered by the 11 employee’s employer.’’. 12 (b) EFFECTIVE DATE.—The amendment made by 13 this section shall apply to taxable years beginning after 14 December 31, 2025. 15 SEC. 2014. EMPLOYER CREDIT FOR CHOICE ARRANGE- 16 MENT. 17 (a) IN GENERAL.—Subpart D of part IV of sub- 18 chapter A of chapter 1 is amended by adding at the end 19 the following new section: 20 ‘‘SEC. 45BB. EMPLOYER CREDIT FOR CHOICE ARRANGE- 21 MENT. 22 ‘‘(a) IN GENERAL.—For purposes of section 38, in 23 the case of an eligible employer, the CHOICE arrange- 24 ment credit determined under this section for any taxable 25 year is an amount, with respect to each employee enrolled 26 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 56 •HR 6512 IH during the credit period in a CHOICE arrangement main- 1 tained by the employer, equal to— 2 ‘‘(1) $100 multiplied by the number of months 3 for which the employee is so enrolled during the first 4 year in the credit period, and 5 ‘‘(2) one-half of the dollar amount in effect 6 under paragraph (1) for the taxable year, multiplied 7 by the number of months for which the employee is 8 so enrolled during the second year of the credit pe- 9 riod. 10 ‘‘(b) ARRANGEMENT MUST CONSTITUTE MINIMUM 11 ESSENTIAL COVERAGE.—An employee shall not be taken 12 into account under subsection (a) unless such employee’s 13 eligibility for the CHOICE arrangement (determined with- 14 out regard to the employee being enrolled) would cause 15 the employee to be treated under section 36B(c)(2) as 16 being eligible for minimum essential coverage consisting 17 of an eligible employer-sponsored plan (as defined in sec- 18 tion 5000A(f)(2)). 19 ‘‘(c) DEFINITIONS.—For purposes of this section— 20 ‘‘(1) CHOICE ARRANGEMENT.—The term 21 ‘CHOICE arrangement’ means a custom health op- 22 tion and individual care expense arrangement (as de- 23 fined in section 9815(b)(2)(B)). 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 57 •HR 6512 IH ‘‘(2) CREDIT PERIOD.—The credit period with 1 respect to an eligible employer is the first 2 one-year 2 periods beginning with the month during which the 3 employer first establishes a CHOICE arrangement 4 on behalf of employees of the employer. 5 ‘‘(3) ELIGIBLE EMPLOYER.—The term ‘eligible 6 employer’ means, with respect to any taxable year 7 beginning in a calendar year, an employer who is not 8 an applicable large employer for the calendar year 9 under section 4980H. 10 ‘‘(d) INFLATION ADJUSTMENT.— 11 ‘‘(1) IN GENERAL.—In the case of any taxable 12 year beginning in a calendar year after 2026, the 13 dollar amount in subsection (a) shall be increased by 14 an amount equal to— 15 ‘‘(A) such dollar amount, multiplied by 16 ‘‘(B) the cost-of-living adjustment deter- 17 mined under section 1(f)(3) for the calendar 18 year in which such taxable year begins by sub- 19 stituting ‘calendar year 2025’ for ‘calendar year 20 2016’ in subparagraph (A)(ii) thereof. 21 ‘‘(2) ROUNDING.—If any amount after adjust- 22 ment under paragraph (1) is not a multiple of $10, 23 such amount shall be rounded to the next lower mul- 24 tiple of $10.’’. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 58 •HR 6512 IH (b) CREDIT MADE PART OF GENERAL BUSINESS 1 CREDIT.—Section 38(b) is amended by striking ‘‘plus’’ at 2 the end of paragraph (40), by striking the period at the 3 end of paragraph (41) and inserting ‘‘, plus’’, and by add- 4 ing at the end the following new paragraph: 5 ‘‘(42) the CHOICE arrangement credit deter- 6 mined under section 45BB(a).’’. 7 (c) CREDIT ALLOWED AGAINST ALTERNATIVE MIN- 8 IMUM TAX.—Section 38(c)(4)(B) is amended— 9 (1) by redesignating clauses (x), (xi), and (xii) 10 as clauses (xi), (xii), and (xiii), respectively, and 11 (2) by inserting after clause (ix) the following 12 new clause: 13 ‘‘(x) the credit determined under sec- 14 tion 45BB,’’. 15 (d) CLERICAL AMENDMENT.—The table of sections 16 for subpart D of part IV of subchapter A of chapter 1 17 is amended by adding at the end the following new item: 18 (e) EFFECTIVE DATE.—The amendments made by 19 this section shall apply to taxable years beginning after 20 December 31, 2025. 21 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 59 •HR 6512 IH Subtitle C—Self-Insurance 1 Protection Act 2 SEC. 2021. SHORT TITLE. 3 This Act may be cited as the ‘‘Self-Insurance Protec- 4 tion Act’’. 5 SEC. 2022. FINDINGS. 6 Congress finds the following: 7 (1) Small and large employers offer health ben- 8 efit plan coverage to employees in self-funded ar- 9 rangements using company assets or a fund, or by 10 paying premiums to purchase fully-insured coverage 11 from a health insurance company. 12 (2) Employers that self-fund health benefit 13 plans will often purchase stop-loss insurance as a fi- 14 nancial risk management tool to protect against ex- 15 cess or unexpected catastrophic health plan claims 16 losses that arise above projected costs paid out of 17 company assets. 18 (3) Stop-loss coverage insures the employer 19 sponsoring the health benefit plan against unfore- 20 seen health plan claims, does not insure the em- 21 ployee health benefit plan itself, and does not pay 22 health care providers for medical services provided to 23 the employees. 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 60 •HR 6512 IH (4) Employer-sponsored health benefit plans are 1 regulated under the Employee Retirement Income 2 Security Act of 1974, however, States regulate the 3 availability and the coverage terms of stop-loss in- 4 surance coverage that employers purchase to protect 5 company assets and to protect a fund against excess 6 or unexpected claims losses. 7 (5) Both large and small employers that choose 8 to self-fund must also be able to protect company as- 9 sets or a fund against excess or unexpected claims 10 losses and States must reasonably regulate stop-loss 11 insurance to assure its availability to both large and 12 small employers. 13 SEC. 2023. CERTAIN MEDICAL STOP-LOSS INSURANCE OB- 14 TAINED BY CERTAIN PLAN SPONSORS OF 15 GROUP HEALTH PLANS NOT INCLUDED 16 UNDER THE DEFINITION OF HEALTH INSUR- 17 ANCE COVERAGE. 18 Section 733(b)(1) of the Employee Retirement In- 19 come Security Act of 1974 (29 U.S.C. 1191b(b)(1)) is 20 amended by adding at the end the following sentence: 21 ‘‘Such term shall not include a stop-loss policy obtained 22 by a self-insured group health plan or a plan sponsor of 23 a group health plan that self-insures the health risks of 24 its plan participants to reimburse the plan or sponsor for 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 61 •HR 6512 IH losses that the plan or sponsor incurs in providing health 1 or medical benefits to such plan participants in excess of 2 a predetermined level set forth in the stop-loss policy ob- 3 tained by such plan or sponsor.’’. 4 SEC. 2024. EFFECT ON OTHER LAWS. 5 Section 514(b) of the Employee Retirement Income 6 Security Act of 1974 (29 U.S.C. 1144(b)) is amended by 7 adding at the end the following: 8 ‘‘(10) The provisions of this title (including 9 part 7 relating to group health plans) shall preempt 10 State laws insofar as they may now or hereafter pre- 11 vent an employee benefit plan that is a group health 12 plan from insuring against the risk of excess or un- 13 expected health plan claims losses.’’. 14 Subtitle D—Small Business 15 Flexibility Act 16 SEC. 2031. SHORT TITLE. 17 This Act may be cited as the ‘‘Small Business Flexi- 18 bility Act’’. 19 SEC. 2032. NOTIFICATION OF FLEXIBLE HEALTH INSUR- 20 ANCE BENEFITS. 21 (a) IN GENERAL.—Subchapter C of chapter 100 of 22 the Internal Revenue Code of 1986 is amended by adding 23 at the end the following new section: 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 62 •HR 6512 IH ‘‘SEC. 9835. NOTIFICATION OF FLEXIBLE HEALTH INSUR- 1 ANCE BENEFITS. 2 ‘‘(a) IN GENERAL.—Not later than 1 year after the 3 date of enactment of this section, the Secretary shall no- 4 tify employers of the availability of tax-advantaged flexible 5 health insurance benefits, with an initial focus on small 6 businesses, particularly in rural areas (as defined in sec- 7 tion 1393(a)(2)). 8 ‘‘(b) DEFINITIONS.—In this section: 9 ‘‘(1) EMPLOYER.—The term ‘employer’ has the 10 meaning given such term in section 3(5) of the Em- 11 ployee Retirement Income Security Act (29 U.S.C. 12 1002(5)). 13 ‘‘(2) FLEXIBLE HEALTH INSURANCE BENE- 14 FITS.—The term ‘flexible health insurance benefits’ 15 means— 16 ‘‘(A) an individual contribution health re- 17 imbursement arrangement (as described in the 18 rule entitled ‘Health Reimbursement Arrange- 19 ments and Other Account-Based Group Health 20 Plans’ (84 Fed. Reg. 28888 (June 20, 2019))); 21 ‘‘(B) a qualified small employer health re- 22 imbursement arrangement (as defined in sec- 23 tion 9831(d)(2)); and 24 ‘‘(C) the small employer health insurance 25 credit determined under section 45R.’’. 26 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 63 •HR 6512 IH (b) CLERICAL AMENDMENT.—The table of sections 1 for subchapter C of chapter 100 of such Code is amended 2 by adding at the end the following new item: 3 ‘‘Sec. 9835. Notification of flexible health insurance benefits’’. Subtitle E—Health Coverage 4 Choice Act 5 SEC. 2041. SHORT TITLE. 6 This Act may be cited as the ‘‘Health Coverage 7 Choice Act’’. 8 SEC. 2042. DEFINITION OF SHORT-TERM LIMITED DURA- 9 TION INSURANCE. 10 Section 2791(b) of the Public Health Service Act (42 11 U.S.C. 300gg–91(b)) is amended by adding at the end the 12 following new paragraph: 13 ‘‘(6) SHORT-TERM LIMITED DURATION INSUR- 14 ANCE.—The term ‘short-term limited duration insur- 15 ance’ means health insurance coverage provided 16 under a contract with a health insurance issuer 17 that— 18 ‘‘(A) has an expiration date specified in 19 the contract that is less than 12 months after 20 the original effective date of the contract; and 21 ‘‘(B) has a duration of not more than 10 22 years (taking into account renewals or exten- 23 sions) after the original effective date of the 24 contract.’’. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 64 •HR 6512 IH Subtitle F—IMPACT Act of 2025 1 SEC. 2051. SHORT TITLE. 2 This Act may be cited as the ‘‘Improved Medical Pa- 3 tients Affordable Care Today Act of 2025’’ or the ‘‘IM- 4 PACT Act of 2025.’’ 5 SEC. 2052. EXPANDING ELIGIBILITY FOR CATASTROPHIC 6 PLANS. 7 (a) IN GENERAL.—Section 1302(e)(2) of the Patient 8 Protection and Affordable Care Act (42. U.S.C. 9 18022(e)(2) is amended— 10 (1) in subparagraph (B)(ii), by striking the pe- 11 riod at the end and inserting ‘‘; or’’; and 12 (2) by adding at the end the following new sub- 13 paragraph: 14 ‘‘(C) with respect to the plan year involved, 15 is determined to be ineligible (or reasonably ex- 16 pects to be ineligible) for the premium tax cred- 17 it under section 36B of the Internal Revenue 18 Code of 1986 or for reduced cost-sharing under 19 section 1402 on the basis of the individual’s 20 household income for such year.’’. 21 (b) EFFECTIVE DATE.—The amendments made by 22 this section shall apply with respect to plan years begin- 23 ning on or after January 1, 2026. 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 65 •HR 6512 IH Subtitle G—New Health Options 1 Act 2 SEC. 2061. SHORT TITLE. 3 This Act may be cited as the ‘‘New Health Options 4 Act’’. 5 SEC. 2062. CREATION OF A REINSURANCE PROGRAM FOR A 6 NEW HEALTH INSURANCE RISK POOL. 7 (a) IN GENERAL.—Part V of subtitle B of title I of 8 the Patient Protection and Affordable Care Act (42 9 U.S.C. 18061 et seq.) is amended by adding at the end 10 the following new section: 11 ‘‘SEC. 1344. REINSURANCE PROGRAM FOR CERTAIN OFF-EX- 12 CHANGE PLANS. 13 ‘‘(a) IN GENERAL.—There is established a Reinsur- 14 ance Program, to be administered by the Secretary of 15 Health and Human Services, to provide payments to 16 health insurance issuers with respect to claims for eligible 17 individuals for the purpose of lowering premiums for such 18 individuals. 19 ‘‘(b) FUNDING.— 20 ‘‘(1) APPROPRIATION.—For the purpose of pro- 21 viding funding for the Reinsurance Program, for 22 each year during the period beginning on January 1, 23 2026, and ending on December 31, 2030, there is 24 appropriated out of any monies in the Treasury not 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 66 •HR 6512 IH otherwise obligated an amount equal to the product 1 of $50 and the aggregate number of member months 2 for all eligible individuals enrolled in a covered plan 3 during such year. 4 ‘‘(2) LIMITATION ON APPROPRIATION.—In no 5 year shall the appropriation for the Reinsurance 6 Program authorized in paragraph (1) exceed 7 $6,000,000,000. 8 ‘‘(3) USE OF UNEXPENDED FUNDS.—Appro- 9 priated amounts remaining unexpended at the end of 10 any year may be used to make payments under the 11 Reinsurance Program in any future year. 12 ‘‘(4) LIMITATION ON USE OF FUNDS.—No 13 funds received under the Reinsurance Program may 14 be used to pay for services described in section 15 1303(b)(1)(B)(i) (as in effect on the date of the en- 16 actment of this section). 17 ‘‘(c) OPERATION OF PROGRAM.— 18 ‘‘(1) IN GENERAL.—The Secretary shall estab- 19 lish parameters for the operation of the Reinsurance 20 Program consistent with this section. 21 ‘‘(2) DEADLINE FOR INITIAL OPERATION.—Not 22 later than 120 days after the date of the enactment, 23 the Secretary shall establish sufficient parameters to 24 specify how the Program will operate for 2026. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 67 •HR 6512 IH ‘‘(3) DEFINITIONS.—In this section: 1 ‘‘(A) COVERED PLAN.—The term ‘covered 2 plan’ means individual health insurance cov- 3 erage (as such term is defined in section 2791 4 of the Public Health Service Act)— 5 ‘‘(i) with respect to which the issuer 6 of such coverage has made the election de- 7 scribed in section 1312(c)(1)(A); and 8 ‘‘(ii) that does not provide coverage 9 for services described in section 10 1303(b)(1)(B)(i) (as in effect on the date 11 of the enactment of this section). 12 ‘‘(B) ELIGIBLE INDIVIDUAL.—The term 13 ‘eligible individual’ means an individual enrolled 14 in a covered plan. 15 ‘‘(d) ATTACHMENT DOLLAR AMOUNT AND PAYMENT 16 PROPORTION.— 17 ‘‘(1) IN GENERAL.—The Secretary shall annu- 18 ally establish an attachment point, payment propor- 19 tion, and reinsurance cap with respect to claims for 20 eligible individuals for payments under the Reinsur- 21 ance Program, consistent with the following: 22 ‘‘(A) The attachment point for the period 23 beginning January 1, 2026, and ending Decem- 24 ber 31, 2026, shall be $110,000. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 68 •HR 6512 IH ‘‘(B) The payment proportion for the pe- 1 riod beginning January 1, 2026, and ending 2 December 31, 2026, shall be 90 percent. 3 ‘‘(C) The reinsurance cap for the period 4 beginning January 1, 2026 and ending Decem- 5 ber 31, 2026, shall be $300,000. 6 ‘‘(2) ADJUSTMENT AUTHORITY.—The Secretary 7 may adjust any amounts described in paragraph (1) 8 as necessary to ensure the Reinsurance Program 9 does not make payment for a year in excess of the 10 amount available for such year under subsection 11 (b).’’. 12 (b) ELECTION TO OPT OUT OF SINGLE RISK 13 POOL.— 14 (1) IN GENERAL.—Section 1312(c)(1) of the 15 Patient Protection and Affordable Care Act (42 16 U.S.C. 18032(c)(1)) is amended— 17 (A) by striking ‘‘A health insurance 18 issuer’’ and inserting the following: 19 ‘‘(A) IN GENERAL.—A health insurance 20 issuer’’; 21 (B) in subparagraph (A), as inserted by 22 paragraph (1), by inserting ‘‘and other than 23 any health plan with respect to which such 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 69 •HR 6512 IH issuer has elected for this subparagraph not to 1 apply’’ after ‘‘grandfathered health plans’’; and 2 (C) by adding at the end the following new 3 subparagraph: 4 ‘‘(B) TREATMENT OF PLANS OPTING OUT 5 OF SINGLE RISK POOL.—A health insurance 6 issuer shall consider all enrollees in all health 7 plans offered by such issuer in the individual 8 market with respect to which such issuer has 9 made the election described in subparagraph 10 (A) to be members of a single risk pool.’’. 11 (2) PROHIBITING SINGLE RISK POOL OPT OUT 12 FOR QUALIFIED HEALTH PLANS.—Section 13 1301(a)(1)(C) of the Patient Protection and Afford- 14 able Care Act (42 U.S.C. 18021(a)(1)) is amend- 15 ed— 16 (A) in clause (iii), by striking ‘‘and’’ at the 17 end; 18 (B) in clause (iv), by striking the period 19 and inserting ‘‘; and’’; and 20 (C) by adding at the end the following new 21 clause: 22 ‘‘(v) has not made the election described in section 23 1312(c)(1)(A) with respect to such plan.’’. 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 70 •HR 6512 IH (3) EFFECTIVE DATE.—The amendments made 1 by this subsection shall apply with respect to plan 2 years beginning on or after January 1, 2026. 3 (c) REMOVING AGE PREMIUM VARIATION LIMITA- 4 TION FOR CERTAIN PLANS.— 5 (1) IN GENERAL.— 6 (A) REMOVAL OF LIMITATION FOR CER- 7 TAIN PLANS.—Section 2701(a)(1)(A)(iii) of the 8 Public Health Service Act (42 U.S.C 9 300gg(a)(1)(A)(iii)) is amended by inserting 10 ‘‘or, in the case of such coverage with respect 11 to which the issuer of such coverage has made 12 the election described in section 1312(c)(1)(A) 13 of the Patient Protection and Affordable Care 14 Act, by more than an actuarially justified 15 amount for adults’’ before ‘‘; and’’. 16 (B) EFFECTIVE DATE.—The amendment 17 made by subparagraph (A) shall apply with re- 18 spect to plan years beginning on or after Janu- 19 ary 1, 2026. 20 (2) MAINTAINING AGE PREMIUM VARIATION 21 LIMITATION FOR QUALIFIED HEALTH PLANS.—Sec- 22 tion 1301(a)(1) of the Patient Protection and Af- 23 fordable Care Act (42 U.S.C. 18021(a)(1)), as 24 amended by subsection (b), is further amended— 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 71 •HR 6512 IH (A) in subparagraph (B), by striking 1 ‘‘and’’ at the end; 2 (B) in subparagraph (C)(v), by striking 3 the period and inserting ‘‘; and’’; and 4 (C) by adding at the end the following new 5 subparagraph: 6 ‘‘(D) with respect to the premium rate 7 charged by such plan, if such plan varies such 8 rate by age, does not vary such rate by more 9 than 3 to 1 for adults (consistent with section 10 2707(c) of the Public Health Service Act).’’. 11 (d) TREATMENT OF OPT OUT PLANS IN RELATION 12 TO INDIVIDUAL HEALTH COVERAGE REIMBURSEMENT 13 ARRANGEMENTS.—The Secretaries of Health and Human 14 Services, Labor, and the Treasury shall not fail to treat 15 any individual health insurance coverage (as defined in 16 section 2791 of the Public Health Service Act (42 U.S.C. 17 300gg–91)) as eligible for integration with an individual 18 health care reimbursement arrangement on the basis that 19 the health insurance issuer (as so defined) of such cov- 20 erage has made the election described in section 21 1312(c)(1)(A) of the Patient Protection and Affordable 22 Care Act (as inserted by subsection (b)). 23 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 72 •HR 6512 IH SEC. 2062. PROMOTION OF HIGH-VALUE CARE. 1 (a) IN GENERAL.—Subpart II of part A of title 2 XXVII of the Public Health Service Act (42 U.S.C. 3 300gg–11 et seq.) is amended by adding at the end the 4 following new section: 5 ‘‘SEC. 2730. APPLICATION OF CERTAIN OUT-OF-NETWORK 6 COSTS TO DEDUCTIBLES AND OUT-OF-POCK- 7 ET MAXIMUMS. 8 ‘‘(a) IN GENERAL.—A group health plan, and a 9 health insurance issuer offering group or individual health 10 insurance coverage, shall, in the case that an individual 11 enrolled under such plan or coverage is furnished items 12 or services by a health care provider or health care facility 13 that does not have in effect a contractual relationship with 14 such plan or issuer for the furnishing of such items or 15 services and such individual incurs any out-of-pockets 16 costs with respect to such items and services, at the option 17 of such individual, apply such costs to any deductible or 18 out-of-pocket maximum applicable to items and services 19 furnished by health care providers or health care facilities 20 with contracts in effect with such plan or issuer for the 21 furnishing of such items or services, but only if the fol- 22 lowing requirements are met: 23 ‘‘(1) The item or service furnished by such pro- 24 vider or facility without a contract in effect with 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 73 •HR 6512 IH such plan or issuer is an item or service for which 1 benefits are available under such plan or coverage. 2 ‘‘(2) The amount charged by such provider or 3 facility for such item or service is equal to or less 4 than— 5 ‘‘(A) the lowest amount recognized by the 6 plan or coverage as payment for such item or 7 service out of all health care providers and 8 health care facilities with a contract in effect 9 with such plan or issuer to furnish such item or 10 service in the same rating area (as defined for 11 purposes of section 2701) in which the item or 12 service described in paragraph (1) was fur- 13 nished; or 14 ‘‘(B) the 25th percentile of charges for 15 such item or service furnished in the same 16 State in which the item or service described in 17 paragraph (1) was furnished. 18 ‘‘(b) DISCLOSURE OF INFORMATION.—A group 19 health plan, and a health insurance issuer offering group 20 or individual health insurance coverage, shall, with respect 21 to each item or service for which benefits are available 22 under such plan or coverage, make available the lowest 23 amount described in subsection (a)(2)(A) and the 25th 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 74 •HR 6512 IH percentile described in subsection (a)(2)(B) to all individ- 1 uals enrolled under such plan or coverage.’’. 2 (b) EFFECTIVE DATE.—The amendment made by 3 subsection (a) shall apply to plan years beginning on or 4 after January 1, 2026. 5 SEC. 2064. DISCLOSURE OF LOWER PRICES. 6 Part E of title XXVII of the Public Health Service 7 Act (42 U.S.C. 300gg–131) is amended by adding at the 8 end the following new section: 9 ‘‘SEC. 2799B–10. DISCLOSURE OF LOWER PRICES. 10 ‘‘(a) IN GENERAL.—Beginning January 1, 2026, 11 each health care provider and health care facility shall dis- 12 close to patients and prospective patients enrolled in a 13 group health plan, group or individual health insurance 14 coverage, or a Federal health care program (as defined 15 in section 1128B but including the program established 16 under chapter 89 of title 5, United States Code) being 17 furnished or seeking to be furnished an item or service 18 by such provider or facility for which benefits are available 19 under such plan, coverage, or program, as applicable, 20 whether the amount of cost sharing (including deductibles, 21 copayments, and coinsurance) that would be incurred by 22 such individual for such item or service under such plan, 23 coverage, or program, as applicable, exceeds the charge 24 that would apply for such item or service for an individual 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 75 •HR 6512 IH without benefits under any such plan, coverage, or pro- 1 gram for such item or service. 2 ‘‘(b) ADDITIONAL ENFORCEMENT.—In addition to 3 any other penalty applicable with respect to a violation of 4 subsection (a), an individual who is harmed by a violation 5 of this section by a health care provider or health care 6 facility may bring an action against such provider or facil- 7 ity in an appropriate district court of the United States 8 for— 9 ‘‘(1) appropriate injunctive relief; and 10 ‘‘(2) damages in an amount that is equal to the 11 amount provided for such harm in a civil action 12 under the law of the State in which the provider or 13 facility is located.’’. 14 Subtitle H—Fighting Waste Fraud 15 and Abuse in the Unaffordable 16 Care Act 17 SEC. 2071. SHORT TITLE. 18 This Act may be cited as the ‘‘Fighting Waste Fraud 19 and Abuse in the Unaffordable Care Exchanges Act of 20 2025’’. 21 SEC. 2072. ADDRESSING WASTE, FRAUD, AND ABUSE IN THE 22 ACA EXCHANGES. 23 (a) CHANGES TO ENROLLMENT PERIODS FOR EN- 24 ROLLING IN EXCHANGES.—Section 1311 of the Patient 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 76 •HR 6512 IH Protection and Affordable Care Act (42 U.S.C. 18031) is 1 amended— 2 (1) in subsection (c)(6)— 3 (A) by striking subparagraph (A); 4 (B) by striking ‘‘The Secretary’’ and in- 5 serting the following: 6 ‘‘(A) IN GENERAL.—The Secretary’’; 7 (C) by redesignating subparagraphs (B) 8 through (D) as clauses (i) through (iii) respec- 9 tively, and adjusting the margins accordingly; 10 (D) in clause (i), as so redesignated, by 11 striking ‘‘periods, as determined by the Sec- 12 retary for calendar years after the initial enroll- 13 ment period;’’ and inserting the following: ‘‘pe- 14 riods for plans offered in the individual mar- 15 ket— 16 ‘‘(I) for enrollment for plan years 17 beginning before January 1, 2027, as 18 determined by the Secretary; and 19 ‘‘(II) for enrollment for plan 20 years beginning on or after January 21 1, 2027, beginning on November 1, 22 and ending on December 15 of the 23 preceding calendar year;’’. 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 77 •HR 6512 IH (E) in clause (ii), as so redesignated, by 1 inserting ‘‘subject to subparagraph (B),’’ before 2 ‘‘special enrollment period specified’’; and 3 (F) by adding at the end the following new 4 subparagraph; 5 ‘‘(B) PROHIBITED SPECIAL ENROLLMENT 6 PERIOD.—With respect to plans years beginning 7 on or after January 1, 2027, the Secretary may 8 not require an Exchange to provide for a spe- 9 cial enrollment period for an individual on the 10 basis of the relationship of the income of such 11 individual to the poverty line, other than a spe- 12 cial enrollment period based on a change in cir- 13 cumstances or the occurrence of a specific 14 event.’’; 15 (2) in subsection (d), by adding at the end the 16 following new paragraphs: 17 ‘‘(8) PROHIBITED ENROLLMENT PERIODS.—An 18 exchange may not provide for, with respect to enroll- 19 ment for plan years beginning on or after January 20 1, 2027— 21 ‘‘(A) an annual open enrollment period 22 other than the period described in subpara- 23 graph (A)(i) of subsection (c)(6); or 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 78 •HR 6512 IH ‘‘(B) a special enrollment period described 1 in subparagraph (B) of such subsection. 2 ‘‘(9) VERIFICATION OF ELIGIBILITY FOR SPE- 3 CIAL ENROLLMENT PERIODS.— 4 ‘‘(A) IN GENERAL.—With respect to enroll- 5 ment for plan years beginning on or after Janu- 6 ary 1, 2027, an Exchange shall verify that each 7 individual seeking to enroll in a qualified health 8 plan offered by the Exchange during a special 9 enrollment period selected under paragraph (B) 10 is eligible to enroll during such special enroll- 11 ment period prior to enrolling such individual in 12 such plan. 13 ‘‘(B) SELECTED SPECIAL ENROLLMENT 14 PERIODS.—For purposes of subparagraph (A), 15 an Exchange shall select one or more special 16 enrollment periods for a plan year with respect 17 to which such Exchange shall conduct the 18 verification required under subparagraph (A) 19 such that the Exchange conducts such 20 verification for not less than 75 percent of all 21 individuals enrolling in a qualified health plan 22 offered by the Exchange during any special en- 23 rollment period with respect to such plan 24 year.’’. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 79 •HR 6512 IH (b) VERIFYING INCOME FOR INDIVIDUALS EN- 1 ROLLED IN A QUALIFIED HEALTH PLAN THROUGH AN 2 EXCHANGE.— 3 (1) IN GENERAL.—Section 1411(e)(4) of the 4 Patient Protection and Affordable Care Act (42 5 U.S.C. 18081(e)(4)) is amended— 6 (A) by redesignating subparagraph (C) as 7 subparagraph (E); and 8 (B) by inserting after subparagraph (B) 9 the following new subparagraphs: 10 ‘‘(C) REQUIRING VERIFICATION OF IN- 11 COME AND FAMILY SIZE WHEN TAX DATA IS 12 UNAVAILABLE.—For plan years beginning on or 13 after January 1, 2027, for purposes of subpara- 14 graph (A), in the case that the Exchange re- 15 quests data from the Secretary of the Treasury 16 regarding an individual’s household income and 17 the Secretary of the Treasury does not return 18 such data, such information may not be verified 19 solely on the basis of the attestation of such in- 20 dividual with respect to such household income, 21 and the Exchange shall take the actions de- 22 scribed in subparagraph (A). 23 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 80 •HR 6512 IH ‘‘(D) REQUIRING VERIFICATION OF IN- 1 COME IN THE CASE OF CERTAIN INCOME DIS- 2 CREPANCIES.— 3 ‘‘(i) IN GENERAL.—Subject to clause 4 (iii), for plan years beginning on or after 5 January 1, 2027, for purposes of subpara- 6 graph (A), in the case that a specified in- 7 come discrepancy described in clause (ii) of 8 this subparagraph exists with respect to 9 the information provided by an applicant 10 under subsection (b)(3), the household in- 11 come of such individual shall be treated as 12 inconsistent with information in the 13 records maintained by persons under sub- 14 section (c), or as not verified under sub- 15 section (d), and the Exchange shall take 16 the actions described in such subparagraph 17 (A). 18 ‘‘(ii) SPECIFIED INCOME DISCREP- 19 ANCY.—For purposes of clause (i), a speci- 20 fied income discrepancy exists with respect 21 to the information provided by an appli- 22 cant under subsection (b)(3) if— 23 ‘‘(I) the applicant attests to a 24 projected annual household income 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 81 •HR 6512 IH that would qualify such applicant to 1 be an applicable taxpayer under sec- 2 tion 36B(c)(1)(A) of the Internal Rev- 3 enue Code of 1986 with respect to the 4 taxable year involved; 5 ‘‘(II) the Exchange receives data 6 from the Secretary of the Treasury or 7 other reliable, third party data, that 8 indicates that the household income of 9 such applicant is less than the house- 10 hold income that would qualify such 11 applicant to be an applicable taxpayer 12 under such section 36B(c)(1)(A) with 13 respect to the taxable year involved; 14 ‘‘(III) such attested projected an- 15 nual household income exceeds the in- 16 come reflected in the data described in 17 subclause (II) by a reasonable thresh- 18 old established by the Exchange and 19 approved by the Secretary (which 20 shall be not less than 10 percent, and 21 may also be a dollar amount); and 22 ‘‘(IV) the Exchange has not as- 23 sessed or determined based on the 24 data described in subclause (II) that 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 82 •HR 6512 IH the household income of the applicant 1 meets the applicable income-based eli- 2 gibility standard for the Medicaid pro- 3 gram under title XIX of the Social 4 Security Act or the State children’s 5 health insurance program under title 6 XXI of such Act. 7 ‘‘(iii) EXCLUSION OF CERTAIN INDI- 8 VIDUALS INELIGIBLE FOR MEDICAID.—The 9 subparagraph shall not apply in the case of 10 an applicant who is an alien lawfully 11 present in the United States, who is not el- 12 igible for the Medicaid program under title 13 XIX of the Social Security Act by reason 14 of such alien status.’’. 15 (2) REQUIRING INDIVIDUALS ON WHOSE BE- 16 HALF ADVANCE PAYMENTS OF THE PREMIUM TAX 17 CREDIT ARE MADE TO FILE AND RECONCILE ON AN 18 ANNUAL BASIS.—Section 1412(b) of the Patient 19 Protection and Affordable Care Act (42 U.S.C. 20 18082(b)) is amended by adding at the end the fol- 21 lowing new paragraph: 22 ‘‘(3) ANNUAL REQUIREMENT TO FILE AND REC- 23 ONCILE.— 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 83 •HR 6512 IH ‘‘(A) IN GENERAL.—For plan years begin- 1 ning on or after January 1, 2027, in the case 2 of an individual with respect to whom any ad- 3 vance payment of the premium tax credit allow- 4 able under section 36B of the Internal Revenue 5 Code of 1986 was made under this section to 6 the issuers of a qualified health plan for the rel- 7 evant prior tax year, an advance determination 8 of eligibility for such premium tax credit may 9 not be made under this subsection with respect 10 to such individual and such plan year if the Ex- 11 change determines, based on information pro- 12 vided by the Secretary of the Treasury, that 13 such individual— 14 ‘‘(i) has not filed an income tax re- 15 turn, as required under section 6011 and 16 6012 of such code (and implementing reg- 17 ulations), for the relevant prior tax year; 18 or 19 ‘‘(ii) as necessarily, has not been rec- 20 onciled (in accordance with subsection (f) 21 of such section 36B) the advance payment 22 of the premium tax credit made with re- 23 spect to such individual for such relevant 24 prior tax year. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 84 •HR 6512 IH ‘‘(B) RELEVANT PRIOR TAX YEAR.—For 1 purposes of subparagraph (A), the term ‘rel- 2 evant prior tax year’ means, with respect to the 3 advance determination of eligibility made under 4 this subsection with respect to an individual, 5 the taxable year for which tax return data 6 would be used for purposes of verifying the 7 household income and family size of such indi- 8 vidual (as described in section 1411(b)(3)(A)). 9 ‘‘(C) PRELIMINARY ATTESTATION.—If an 10 individual subject to subparagraph (A) attests 11 that such individual has fulfilled the require- 12 ments to file an income tax return for the rel- 13 evant prior tax year and, as necessary, to rec- 14 oncile the advance payment of the premium tax 15 credit made with respect to such individual for 16 such relevant prior tax year (as described in 17 clauses (i) and (ii) of such subparagraph), the 18 Secretary may make an initial advance deter- 19 mination of eligibility with respect to such indi- 20 vidual and may delay for a reasonable period 21 (as determined by the Secretary) any deter- 22 mination based on information provided by the 23 Secretary of the Treasury that such individual 24 has not fulfilled such requirements. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 85 •HR 6512 IH ‘‘(D) NOTICE.—If the Secretary deter- 1 mines that an individual did not meet the re- 2 quirements described in subparagraph (A) with 3 respect to the relevant prior tax year and noti- 4 fies the Exchange of such determination, the 5 Exchange shall comply with the notification re- 6 quirement described in section 155.305(f)(4)(i) 7 of title 45, Code of Federal Regulations (as in 8 effect with respect to plan year 2025).’’. 9 (3) REMOVING AUTOMATIC EXTENSION OF PE- 10 RIOD TO RESOLVE INCOME INCONSISTENCIES.—The 11 Secretary of Health and Human Services shall revise 12 section 155.315(f) of title 45, Code of Federal Regu- 13 lations, to remove paragraph (7) of such section, 14 such that, with respect to enrollment for plan years 15 beginning on or after January 1, 2027, in the case 16 that an Exchange established under subtitle D of 17 title I of the Patient Protection and Affordable Care 18 Act (42 U.S.C. 18021 et seq.) provides an individual 19 applying for enrollment in a qualified health plan 20 with a 90-day period to resolve an inconsistency in 21 the application of such individual pursuant to sec- 22 tion 1411(e)(4)(A)(ii)(II) of such Act, the Exchange 23 may not provide for an automatic extension to such 24 90-day period on the basis that such individual is re- 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 86 •HR 6512 IH quired to present satisfactory documentary evidence 1 to verify household income. 2 (c) REVISING RULES OF ALLOWABLE VARIATION IN 3 ACTUARIAL VALUE OF HEALTH PLANS.—The Secretary 4 of Health and Human Services shall— 5 (1) revise section 156.140(c) of title 45, Code 6 of Federal Regulations, to provide that, for plan 7 years beginning on or after January 1, 2027, the al- 8 lowable variation in the actuarial value of a health 9 plan applicable under such section shall be the allow- 10 able variation for such plan applicable under such 11 section for plan year 2022; 12 (2) revise sections 156.29(b)(3) of title 45, 13 Code of Federal Regulations, to provide that, for 14 plan years beginning on or after January 1, 2027, 15 the requirement for a qualified health plan issuer de- 16 scribed in such section is that the issuer ensures 17 that each qualified health plan complies with benefit 18 design standards, as defined in section 156.20 of 19 such title; and 20 (3) revise section 156.400 of title 45, Code of 21 Federal Regulations, to provide that, for plans years 22 beginning on or after January 1, 2027, the term ‘‘de 23 minimum variation for a silver plan variation’’ 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 87 •HR 6512 IH means a minus 1 percentage point and plus 1 per- 1 centage point allowable actuarial value variation. 2 (d) UPDATING PREMIUM ADJUSTMENT PERCENTAGE 3 METHODOLOGY.—Section 1302(c)(4) of the Patient Pro- 4 tection and Affordable Care Act (42 U.S.C. 18022(c)(4)) 5 is amended— 6 (1) by striking ‘‘For purposes’’ and inserting: 7 ‘‘(A) IN GENERAL.—For purposes’’; and 8 (2) by adding at the end the following new sub- 9 paragraph: 10 ‘‘(B) UPDATE TO METHODOLOGY.—For 11 calendar years beginning with 2027, the pre- 12 mium adjustment percentage under this para- 13 graph for such calendar year shall be deter- 14 mined consistent with the methodology pub- 15 lished in the Federal Register on April 25, 16 2019 (84 Fed. Reg. 17537 through 17541).’’. 17 (e) ELIMINATING THE FIXED-DOLLAR AND GROSS- 18 PERCENTAGE THRESHOLDS APPLICABLE TO EXCHANGE 19 ENROLLMENTS.—The Secretary of Health and Human 20 Services shall revise section 155.400(g) of title 45, Code 21 of Federal Regulations to eliminate, for plan years begin- 22 ning on or after January 1, 2027, the gross premium per- 23 centage-base premium payment threshold policy described 24 in paragraph (2) of such section and the fixed-dollar pre- 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 88 •HR 6512 IH mium payment threshold policy described in paragraph (3) 1 of such section. 2 (f) PROHIBITING AUTOMATIC REENROLLMENT FROM 3 BRONZE TO SILVER LEVEL QUALIFIED HEALTH PLANS 4 OFFERED BY EXCHANGES.—The Secretary of Health and 5 Human Services shall revise section 155.335(j) of title 45, 6 Code of Federal Regulations, to remove paragraph (4) of 7 such section that, with respect to reenrollments for plan 8 years beginning on or after January 1, 2027, an Exchange 9 established under subtitle D of title I of the Patient Pro- 10 tection and Affordable Care Act (42 U.S.C. 18021 et seq.) 11 may not reenroll an individual who was enrolled in a 12 bronze level qualified health plan in a silver level qualified 13 health plan (as such terms are defined in section 1301(a) 14 and described in 1302(d) of such Act) unless otherwise 15 permitted under section 155.335(j) of title 45, Code of 16 Federal Regulations, as in effect on the day before the 17 date of the enactment of this section. 18 (g) REDUCING ADVANCE PAYMENTS OF PREMIUM 19 TAX CREDITS FOR CERTAIN INDIVIDUALS REENROLLED 20 IN EXCHANGES.—Section 1412 of the Patient Protection 21 and Affordable Care Act (42 U.S.C. 18082) is amended— 22 (1) in subsection (a)(3), by inserting ‘‘, subject 23 to subsection (c)(2)(C),’’ after ‘‘qualified health 24 plans’’; and 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 89 •HR 6512 IH (2) in subsection (c)(2)— 1 (A) in subparagraph (A), by striking 2 ‘‘The’’ and inserting ‘‘Subject to subparagraph 3 (C), the’’; and 4 (B) by adding at the end the following sub- 5 paragraph: 6 ‘‘(C) REDUCTION IN ADVANCE PAYMENT 7 FOR SPECIFIED REENROLLED INDIVIDUALS.— 8 ‘‘(i) IN GENERAL.—The amount of an 9 advance payment made under subpara- 10 graph (A) to reduce the premium payable 11 for a qualified health plan that provides 12 coverage to a specific reenrolled individual 13 for an applicable month shall be an 14 amount equal to the amount that would 15 otherwise be made under such subpara- 16 graph reduced by $5 (or such higher 17 amount as the Secretary determines appro- 18 priate). 19 ‘‘(ii) DEFINITIONS.—In this subpara- 20 graph: 21 ‘‘(I) APPLICABLE MONTH.—The 22 term ‘applicable month’ means, with 23 respect to a specified reenrolled indi- 24 vidual, any month during a plan year 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 90 •HR 6512 IH beginning on or after January 1, 1 2027 (or, in the case of an individual 2 reenrolled in a qualified health plan 3 by an Exchange established pursuant 4 to section 1321(c), January 1, 2027) 5 if, prior to the first day of such 6 month, such individual has failed to 7 confirm or update such information as 8 is necessary to redetermine the eligi- 9 bility of such individual for such plan 10 year pursuant to section 1411(f). 11 ‘‘(II) SPECIFIED REENROLLED 12 INDIVIDUAL.—The term ‘specified re- 13 enrolled individual’ means an indi- 14 vidual who is reenrolled in a qualified 15 health plan and with respect to whom 16 the advance payment made under sub- 17 paragraph (A) would, without applica- 18 tion of any reduction under this sub- 19 paragraph, reduce the premium pay- 20 able for a qualified health plan that 21 provides coverage to such an indi- 22 vidual to $0.’’. 23 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 91 •HR 6512 IH (h) PROHIBITING COVERAGE OF GENDER TRANSI- 1 TION PROCEDURES AS AN ESSENTIAL HEALTH BENEFIT 2 UNDER PLANS OFFERED BY EXCHANGES.— 3 (1) IN GENERAL.—Section 1302(b)(2) of the 4 Patient Protection and Affordable Care Act (42 5 U.S.C. 18022(b)(2)) is amended by adding at the 6 end the following new subparagraph: 7 ‘‘(C) GENDER TRANSITION PROCE- 8 DURES.—For plan years beginning on or after 9 January 1, 2027, the essential health benefits 10 defined pursuant to paragraph (1) may not in- 11 clude items and services furnished for a gender 12 transition procedure.’’. 13 (2) GENDER TRANSITION PROCEDURE DE- 14 FINED.—Section 1304 of the Patient Protection and 15 Affordable Care Act (42 U.S.C. 18024) is amended 16 by adding at the end the following new subsection: 17 ‘‘(f) GENDER TRANSITION PROCEDURE.— 18 ‘‘(1) IN GENERAL.—In this title, except as pro- 19 vided in paragraph (2), the term ‘gender transition 20 procedure’ means, with respect to an individual, any 21 of the following when performed for this purpose of 22 intentionally changing the body of such individual 23 (including by disrupting the body’s development, in- 24 hibiting its natural functions, or modifying its ap- 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 92 •HR 6512 IH pearance) to no longer correspond to the individuals 1 sex: 2 ‘‘(A) Performing any surgery, including— 3 ‘‘(i) castration; 4 ‘‘(ii) sterilization; 5 ‘‘(iii) orchiectomy; 6 ‘‘(iv) scrotoplasty; 7 ‘‘(v) vasectomy; 8 ‘‘(vi) tubal ligation; 9 ‘‘(vii) hysterectomy; 10 ‘‘(viii) oophorectomy; 11 ‘‘(ix) ovariectomy; 12 ‘‘(x) metoidioplasty; 13 ‘‘(xi) clitoroplasty; 14 ‘‘(xii) reconstruction of the fixed part 15 of the urethra with or without a 16 metoidioplasty or a phalloplasty; 17 ‘‘(xiii) penectomy; 18 ‘‘(xiv) phalloplasty; 19 ‘‘(xv) vaginoplasty; 20 ‘‘(xvi) vaginectomy; 21 ‘‘(xvii) vulvoplasty; 22 ‘‘(xviii) reduction thyrochondroplasty; 23 ‘‘(xix) chrondrolaryngoplasty; 24 ‘‘(xx) mastectomy; and 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 93 •HR 6512 IH ‘‘(xxi) any plastic, cosmetic, or aes- 1 thetic surgery that feminizes or 2 masculinizes the facial or other body fea- 3 tures of an individual. 4 ‘‘(B) Any placement of chest implants to 5 create feminine breasts or any placement of 6 erection or testicular prostheses. 7 ‘‘(C) Any placement of fat or artificial im- 8 plants in the gluteal region. 9 ‘‘(D) Administering, prescribing, or dis- 10 pensing to an individual medications, includ- 11 ing— 12 ‘‘(i) gonadotropin-releasing hormone 13 (GnRH) analogues or other puberty-block- 14 ing drugs to stop or delay normal puberty; 15 and 16 ‘‘(ii) testosterone, estrogen, or other 17 androgens to an individual at doses that 18 are superphysiologic than would normally 19 be produced endogenously in a health indi- 20 vidual of the same age and sex. 21 ‘‘(2) EXCEPTION.—Paragraph (1) shall not 22 apply to the following: 23 ‘‘(A) Puberty suppression or blocking pre- 24 scription drugs for the purpose of normalizing 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 94 •HR 6512 IH puberty for an individual experiencing pre- 1 cocious puberty. 2 ‘‘(B) Medically necessary procedures or 3 treatments to correct for— 4 ‘‘(i) a medically verifiable disorder of 5 sex development, including— 6 ‘‘(I) 46, XX chromosomes with 7 virilization; 8 ‘‘(II) 46, XY chromosomes with 9 undervirilization; and 10 ‘‘(III) both ovarian and testicular 11 tissue; 12 ‘‘(ii) sex chromosome structure, sex 13 steroid hormone production, or sex hor- 14 mone action, if determined to be abnormal 15 by a physician through genetic or bio- 16 chemical testing; 17 ‘‘(iii) infection, disease, injury, or dis- 18 order caused or exacerbated by a previous 19 procedure described in paragraph (1), or a 20 physical disorder, physical injury, or phys- 21 ical illness that would, as certified by a 22 physician, place the individual in imminent 23 danger of death or impairment of a major 24 bodily function unless the procedure is per- 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 95 •HR 6512 IH formed, not including procedures per- 1 formed for the alleviation of mental dis- 2 tress; or 3 ‘‘(iv) procedures to restore or recon- 4 struct the body of the individual in order 5 to correspond to the individual’s sex after 6 one or more previous procedures described 7 in paragraph (1), which may include the 8 removal of a pseudo phallus or breast aug- 9 mentation. 10 ‘‘(3) SEX.—For purposes of this subsection, the 11 term ‘sex’ means either male or female, as bio- 12 logically determined and defined by subparagraph 13 (A) and subparagraph (B). 14 ‘‘(A) FEMALE.—The term ‘female’ means 15 an individual who naturally has, had, will have, 16 or would have, but for a developmental or ge- 17 netic anomaly or historical accident, the repro- 18 ductive systems that at some point produces, 19 transports, and utilizes eggs for fertilization. 20 ‘‘(B) MALE.—The term ‘male’ means an 21 individual who naturally has, had, will have, or 22 would have, but for a developmental or genetic 23 anomaly or historical accident, the reproductive 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 96 •HR 6512 IH system that at some point produces, transports, 1 and utilizes sperm for fertilization.’’. 2 (i) ENSURING APPROPRIATE APPLICATION OF GUAR- 3 ANTEED ISSUE REQUIREMENTS IN CASE OF NON-PAY- 4 MENT OF PAST PREMIUMS.— 5 (1) IN GENERAL.—Section 2702 of the Public 6 Health Service Act (42 U.S.C. 300gg–1) is amended 7 by adding at the end the following new subsection: 8 ‘‘(e) NONPAYMENT OF PAST PREMIUMS.— 9 ‘‘(1) IN GENERAL.—A health insurance issuer 10 offering individual health coverage may, to the ex- 11 tent allowed under State law, deny such coverage in 12 the case of an individual who owes any amount for 13 premiums for individual health insurance coverage 14 offered by such issuer (or by a health insurance 15 issuer in the same controlled group (as defined in 16 paragraph (3)) as such issuer) in which such indi- 17 vidual was previously enrolled. 18 ‘‘(2) ATTRIBUTION OF INITIAL PREMIUM PAY- 19 MENT OWED AMOUNT.—A health insurance issued 20 offering individual health insurance coverage may, in 21 the case of an individual described in paragraph (1) 22 and to the extent allowed under State law, attribute 23 the initial premium payment for such coverage appli- 24 cable to such individual to the amount owed by such 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 97 •HR 6512 IH individual for premiums for individual health insur- 1 ance coverage offered by such issuer (or by a health 2 insurance issuer in the same controlled group as the 3 issuer) in which such individual was previously en- 4 rolled. 5 ‘‘(3) CONTROLLED GROUP DEFINED.—For pur- 6 poses of this subsection, the term ‘controlled group’ 7 means a group of two or more persons that is treat- 8 ed as a single employed under section 52(a), 52(b), 9 414(m), or 414(o) of the Internal Revenue Code of 10 1986.’’. 11 (2) EFFECTIVE DATE.—The amendment made 12 by paragraph (1) shall apply with respect to plan 13 years beginning on or after January 1, 2027. 14 SEC. 2073. FUNDING COST-SHARING REDUCTION PAY- 15 MENTS. 16 Section 1402 of the Patient Protection and Afford- 17 able Care Act (42 U.S.C. 18071) is amended by adding 18 at the end the following new subsection: 19 ‘‘(h) FUNDING.— 20 ‘‘(1) IN GENERAL.—There are appropriated out 21 of any monies in the Treasury not otherwise appro- 22 priated such sums as may be necessary for purposes 23 of making payments under this section for plan 24 years beginning on or after January 1, 2027. 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 98 •HR 6512 IH ‘‘(2) LIMITATION.— 1 ‘‘(A) IN GENERAL.—The amounts appro- 2 priated under paragraph (1) may not be used 3 for purposes of making payments under this 4 section for a qualified health plan that provides 5 health benefit coverage that includes coverage 6 of abortion. 7 ‘‘(B) EXCEPTION.—Subparagraph (A) 8 shall not apply to payments for a qualified 9 health plan that provides coverage of abortion 10 only if necessary to save the life of the mother 11 or if the pregnancy is a result of an act of rape 12 or incest.’’. 13 TITLE III—ENDING TAXPAYER 14 FUNDING FOR ABORTION 15 AND GENDER TRANSITION 16 PROCEDURES 17 Subtitle A—No Taxpayer Funding 18 for Abortion and Abortion In- 19 surance Full Disclosure Act of 20 2025 21 SEC. 3000. APPLICABILITY TO ENTIRE ACT. 22 (a) Notwithstanding any other provision of law, the 23 prohibitions and limitations set forth in this title, includ- 24 ing the amendments made by this title, shall apply to all 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 99 •HR 6512 IH funds authorized or appropriated under this Act, including 1 under title I, title II, and every subtitle thereof, and to 2 any trust fund to which such funds are contributed. 3 (b) EFFECTIVE DATE.—This section shall take effect 4 on the date of the enactment of this Act. 5 SEC. 3001. SHORT TITLE. 6 This Act may be cited as the ‘‘No Taxpayer Funding 7 for Abortion and Abortion Insurance Full Disclosure Act 8 of 2025’’. 9 SEC. 3002. PROHIBITING TAXPAYER FUNDED ABORTIONS. 10 Title 1, United States Code, is amended by adding 11 at the end the following new chapter: 12 ‘‘CHAPTER 4—PROHIBITING TAXPAYER 13 FUNDED ABORTIONS 14 ‘‘§ 301. Prohibition on funding for abortions 15 ‘‘No funds authorized or appropriated by Federal 16 law, and none of the funds in any trust fund to which 17 funds are authorized or appropriated by Federal law, shall 18 be expended for any abortion. 19 ‘‘§ 302. Prohibition on funding for health benefits 20 plans that cover abortion 21 ‘‘None of the funds authorized or appropriated by 22 Federal law, and none of the funds in any trust fund to 23 which funds are authorized or appropriated by Federal 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 100 •HR 6512 IH law, shall be expended for health benefits coverage that 1 includes coverage of abortion. 2 ‘‘§ 303. Limitation on federal facilities and employees 3 ‘‘No health care service furnished— 4 ‘‘(1) by or in a health care facility owned or op- 5 erated by the Federal Government; or 6 ‘‘(2) by any physician or other individual em- 7 ployed by the Federal Government to provide health 8 care services within the scope of the physician’s or 9 individual’s employment, may include abortion. 10 ‘‘§ 304. Construction relating to separate coverage 11 ‘‘Nothing in this chapter shall be construed as pro- 12 hibiting any individual, entity, or State or locality from 13 purchasing separate abortion coverage or health benefits 14 coverage that includes abortion so long as such coverage 15 is paid for entirely using only funds not authorized or ap- 16 propriated by Federal law and such coverage shall not be 17 purchased using matching funds required for a federally 18 subsidized program, including a State’s or locality’s con- 19 tribution of Medicaid matching funds. 20 ‘‘§ 305. Construction relating to the use of non-federal 21 funds for health coverage 22 ‘‘Nothing in this chapter shall be construed as re- 23 stricting the ability of any non-Federal health benefits cov- 24 erage provider from offering abortion coverage, or the abil- 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 101 •HR 6512 IH ity of a State or locality to contract separately with such 1 a provider for such coverage, so long as only funds not 2 authorized or appropriated by Federal law are used and 3 such coverage shall not be purchased using matching 4 funds required for a federally subsidized program, includ- 5 ing a State’s or locality’s contribution of Medicaid match- 6 ing funds. 7 ‘‘§ 306. Non-preemption of other federal laws 8 ‘‘Nothing in this chapter shall repeal, amend, or have 9 any effect on any other Federal law to the extent such 10 law imposes any limitation on the use of funds for abortion 11 or for health benefits coverage that includes coverage of 12 abortion, beyond the limitations set forth in this chapter. 13 ‘‘§ 307. Construction relating to complications arising 14 from abortion 15 ‘‘Nothing in this chapter shall be construed to apply 16 to the treatment of any infection, injury, disease, or dis- 17 order that has been caused by or exacerbated by the per- 18 formance of an abortion. This rule of construction shall 19 be applicable without regard to whether the abortion was 20 performed in accord with Federal or State law, and with- 21 out regard to whether funding for the abortion is permis- 22 sible under section 308. 23 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 102 •HR 6512 IH ‘‘§ 308. Treatment of abortions related to rape, incest, 1 or preserving the life of the mother 2 ‘‘The limitations established in sections 301, 302, 3 and 303 shall not apply to an abortion— 4 ‘‘(1) if the pregnancy is the result of an act of 5 rape or incest; or 6 ‘‘(2) in the case where a woman suffers from a 7 physical disorder, physical injury, or physical illness 8 that would, as certified by a physician, place the 9 woman in danger of death unless an abortion is per- 10 formed, including a life-endangering physical condi- 11 tion caused by or arising from the pregnancy itself. 12 ‘‘§ 309. Application to district of columbia 13 ‘‘In this chapter: 14 ‘‘(1) Any reference to funds appropriated by 15 Federal law shall be treated as including any 16 amounts within the budget of the District of Colum- 17 bia that have been approved by an Act of Congress 18 pursuant to section 446 of the District of Columbia 19 Home Rule Act (or any applicable successor Federal 20 law). 21 ‘‘(2) The term ‘Federal Government’ includes 22 the Government of the District of Columbia.’’. 23 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 103 •HR 6512 IH SEC. 3003. AMENDMENT TO TABLE OF CHAPTERS. 1 The table of chapters for title 1, United States Code, 2 is amended by adding at the end the following new item: 3 ‘‘4 Prohibiting taxpayer funded abortions ............................................... 301’’. SEC. 3004. CLARIFYING APPLICATION OF PROHIBITION TO 4 PREMIUM CREDITS AND COST-SHARING RE- 5 DUCTIONS UNDER ACA. 6 (a) IN GENERAL.— 7 (1) DISALLOWANCE OF REFUNDABLE CREDIT 8 AND COST-SHARING REDUCTIONS FOR COVERAGE 9 UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES 10 COVERAGE FOR ABORTION.— 11 (A) IN GENERAL.—Subparagraph (A) of 12 section 36B(c)(3) of the Internal Revenue Code 13 of 1986 is amended by inserting before the pe- 14 riod at the end the following: ‘‘or any health 15 plan that includes coverage for abortions (other 16 than any abortion or treatment described in 17 section 307 or 308 of title 1, United States 18 Code)’’. 19 (B) OPTION TO PURCHASE OR OFFER SEP- 20 ARATE COVERAGE OR PLAN.—Paragraph (3) of 21 section 36B(c) of such Code is amended by 22 adding at the end the following new subpara- 23 graph: 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 104 •HR 6512 IH ‘‘(C) SEPARATE ABORTION COVERAGE OR 1 PLAN ALLOWED.— 2 ‘‘(i) OPTION TO PURCHASE SEPARATE 3 COVERAGE OR PLAN.—Nothing in subpara- 4 graph (A) shall be construed as prohibiting 5 any individual from purchasing separate 6 coverage for abortions described in such 7 subparagraph, or a health plan that in- 8 cludes such abortions, so long as no credit 9 is allowed under this section with respect 10 to the premiums for such coverage or plan. 11 ‘‘(ii) OPTION TO OFFER COVERAGE OR 12 PLAN.—Nothing in subparagraph (A) shall 13 restrict any non-Federal health insurance 14 issuer offering a health plan from offering 15 separate coverage for abortions described 16 in such subparagraph, or a plan that in- 17 cludes such abortions, so long as premiums 18 for such separate coverage or plan are not 19 paid for with any amount attributable to 20 the credit allowed under this section (or 21 the amount of any advance payment of the 22 credit under section 1412 of the Patient 23 Protection and Affordable Care Act).’’. 24 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 105 •HR 6512 IH (2) DISALLOWANCE OF SMALL EMPLOYER 1 HEALTH INSURANCE EXPENSE CREDIT FOR PLAN 2 WHICH INCLUDES COVERAGE FOR ABORTION.—Sub- 3 section (h) of section 45R of the Internal Revenue 4 Code of 1986 is amended— 5 (A) by striking ‘‘Any term’’ and inserting 6 the following: 7 ‘‘(1) IN GENERAL.—Any term’’; and 8 (B) by adding at the end the following new 9 paragraph: 10 ‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING 11 COVERAGE FOR ABORTION.— 12 ‘‘(A) IN GENERAL.—The term ‘qualified 13 health plan’ does not include any health plan 14 that includes coverage for abortions (other than 15 any abortion or treatment described in section 16 307 or 308 of title 1, United States Code). 17 ‘‘(B) SEPARATE ABORTION COVERAGE OR 18 PLAN ALLOWED.— 19 ‘‘(i) OPTION TO PURCHASE SEPARATE 20 COVERAGE OR PLAN.—Nothing in subpara- 21 graph (A) shall be construed as prohibiting 22 any employer from purchasing for its em- 23 ployees separate coverage for abortions de- 24 scribed in such subparagraph, or a health 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 106 •HR 6512 IH plan that includes such abortions, so long 1 as no credit is allowed under this section 2 with respect to the employer contributions 3 for such coverage or plan. 4 ‘‘(ii) OPTION TO OFFER COVERAGE OR 5 PLAN.—Nothing in subparagraph (A) shall 6 restrict any non-Federal health insurance 7 issuer offering a health plan from offering 8 separate coverage for abortions described 9 in such subparagraph, or a plan that in- 10 cludes such abortions, so long as such sep- 11 arate coverage or plan is not paid for with 12 any employer contribution eligible for the 13 credit allowed under this section.’’. 14 (3) CONFORMING ACA AMENDMENTS.—Section 15 1303(b) of Public Law 111–148 (42 U.S.C. 16 18023(b)) is amended— 17 (A) by striking paragraph (2); 18 (B) by striking paragraph (3), as amended 19 by section 202(a); and 20 (C) by redesignating paragraph (4) as 21 paragraph (2). 22 (b) APPLICATION TO MULTI-STATE PLANS.—Para- 23 graph (6) of section 1334(a) of Public Law 111–148 (42 24 U.S.C. 18054(a)) is amended to read as follows: 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 107 •HR 6512 IH ‘‘(6) COVERAGE CONSISTENT WITH FEDERAL 1 ABORTION POLICY.—In entering into contracts 2 under this subsection, the Director shall ensure that 3 no multi-State qualified health plan offered in an 4 Exchange provides health benefits coverage for 5 which the expenditure of Federal funds is prohibited 6 under chapter 4 of title 1, United States Code.’’. 7 (c) EFFECTIVE DATE.—The amendments made by 8 subsection (a) shall apply to taxable years ending after 9 December 31, 2025, but only with respect to plan years 10 beginning after such date, and the amendment made by 11 subsection (b) shall apply to plan years beginning after 12 such date. 13 SEC. 3005. REVISION TO NOTICE REQUIREMENTS REGARD- 14 ING DISCLOSURE OF EXTENT OF HEALTH 15 PLAN COVERAGE OF ABORTION AND ABOR- 16 TION PREMIUM SURCHARGES. 17 (a) IN GENERAL.—Paragraph (3) of section 1303(b) 18 of Public Law 111–148 (42 U.S.C. 18023(b)) is amended 19 to read as follows: 20 ‘‘(3) RULES RELATING TO NOTICE.— 21 ‘‘(A) IN GENERAL.—The extent of cov- 22 erage (if any) of services described in para- 23 graph (1)(B)(i) or (1)(B)(ii) by a qualified 24 health plan shall be disclosed to enrollees at the 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 108 •HR 6512 IH time of enrollment in the plan and shall be 1 prominently displayed in any marketing or ad- 2 vertising materials, comparison tools, or sum- 3 mary of benefits and coverage explanation made 4 available with respect to such plan by the issuer 5 of the plan, by an Exchange, or by the Sec- 6 retary, including information made available 7 through an internet portal or Exchange under 8 sections 1311(c)(5) and 1311(d)(4)(C). 9 ‘‘(B) SEPARATE DISCLOSURE OF ABOR- 10 TION SURCHARGES.—In the case of a qualified 11 health plan that includes the services described 12 in paragraph (1)(B)(i) and where the premium 13 for the plan is disclosed, including in any mar- 14 keting or advertising materials or any other in- 15 formation referred to in subparagraph (A), the 16 surcharge described in paragraph (2)(B)(i)(II) 17 that is attributable to such services shall also be 18 disclosed and identified separately.’’. 19 (b) EFFECTIVE DATE.—The amendment made by 20 subsection (a) shall apply to materials, tools, or other in- 21 formation made available more than 30 days after the date 22 of the enactment of this Act. 23 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 109 •HR 6512 IH Subtitle B—Prohibiting Federal 1 Funding for Gender Transition 2 Procedures 3 SEC. 3006. SHORT TITLE. 4 This Act may be cited as the ‘‘End Taxpayer Fund- 5 ing of Gender Experimentation Act of 2025’’ 6 SEC. 3007. PROHIBITING FEDERAL FUNDING FOR GENDER 7 TRANSITION PROCEDURES. 8 (a) DEFINITION.—In this section, the term ‘‘Speci- 9 fied sex-trait modification procedure’’ means any pharma- 10 ceutical or surgical intervention that is provided for the 11 purpose of attempting to align an individual’s physical ap- 12 pearance or body with an asserted identity that differs 13 from the individual’s sex either by: 14 (1) Intentionally disrupting or suppressing the 15 normal development of natural biological functions, 16 including primary or secondary sex-based traits; or 17 (2) Intentionally altering an individual’s phys- 18 ical appearance or body, including amputating, mini- 19 mizing or destroying primary or secondary sex-based 20 traits such as the sexual and reproductive organs. 21 (3) This term does not include procedures un- 22 dertaken: 23 (A) To treat a person with a medically 24 verifiable disorder of sexual development; or 25 VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS 110 •HR 6512 IH (B) For purposes other than attempting to 1 align an individual’s physical appearance or 2 body with an asserted identity that differs from 3 the individual’s sex. 4 (b) GENERAL PROHIBITION.—Notwithstanding any 5 other provision of law, no Federal funds (including funds 6 provided through grants, contracts, insurance, or any 7 other means) may be used to pay for, reimburse, or other- 8 wise support any specified sex-trait modification proce- 9 dure. 10 (c) EFFECTIVE DATE.—The amendments made by 11 this section shall take effect on the date of the enactment 12 of this Act and shall apply to payments, reimbursements, 13 and services provided on or after such date. 14 Æ VerDate Sep 11 2014 19:34 Feb 02, 2026 Jkt 069200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6301 E:\BILLS\H6512.IH H6512 ssavage on LAPJG3WLY3PROD with BILLS