Text of US HB 6538 (2025)

I 119TH CONGRESS 1ST SESSION H. R. 6538 To establish a health freedom waiver program, to promote better price reporting and outcomes, and for other purposes. IN THE HOUSE OF REPRESENTATIVES DECEMBER 9, 2025 Mr. PFLUGER (for himself, Mr. BEAN of Florida, Mrs. FEDORCHAK, Mr. BAIRD, and Mr. CLYDE) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Com- mittee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To establish a health freedom waiver program, to promote better price reporting and outcomes, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘More Affordable Care 4 Act’’. 5 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 2 •HR 6538 IH SEC. 2. HEALTH FREEDOM WAIVER PROGRAM. 1 Part 4 of subtitle D of title I of the Patient Protec- 2 tion and Affordable Care Act (42 U.S.C. 18051 et seq.) 3 is amended by adding at the end the following: 4 ‘‘SEC. 1335. HEALTH FREEDOM WAIVER PROGRAM. 5 ‘‘(a) IN GENERAL.— 6 ‘‘(1) WAIVER PROGRAM.—The Secretary shall 7 waive all or any requirements described in para- 8 graph (4), as determined by the applicable State, for 9 plan years beginning on or after January 1, 2026, 10 with respect to health insurance coverage within any 11 State that submits a notification under paragraph 12 (2), provided that the State maintains an invisible 13 high-risk insurance pool or another program de- 14 signed to mitigate risk to insurance premium costs. 15 ‘‘(2) NOTIFICATION.—A State entity described 16 in paragraph (3) desiring a waiver under this section 17 for any plan year beginning on or after January 1, 18 2026, shall notify the Secretary of its intent to par- 19 ticipate in the waiver program with respect to all or 20 any requirements described in paragraph (4). Such 21 notification shall be filed at such time, not later than 22 90 days before the State intends to begin participa- 23 tion in the waiver program, and in such manner as 24 the Secretary may require, and contain such infor- 25 mation as the Secretary may require, including the 26 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 3 •HR 6538 IH requirements under paragraph (4) that the State in- 1 tends to waive and evidence that the State maintains 2 a high-risk insurance pool. 3 ‘‘(3) STATE SUBMISSION.—A notification with 4 respect to a State may be submitted by— 5 ‘‘(A) the governor of the State; or 6 ‘‘(B) the legislature of the State, upon a 7 majority vote by the State legislature. 8 ‘‘(4) REQUIREMENTS.—The requirements de- 9 scribed in this paragraph with respect to health in- 10 surance coverage within the State are as follows: 11 ‘‘(A) Part 1 of subtitle D. 12 ‘‘(B) Part 2 of subtitle D. 13 ‘‘(C) Section 1402. 14 ‘‘(D) Sections 36B and 5000A of the In- 15 ternal Revenue Code of 1986. 16 ‘‘(5) MONEY FOLLOWS THE PERSON.— 17 ‘‘(A) IN GENERAL.—With respect to a 18 State waiver under paragraph (1), under which, 19 due to the structure of the State plan, individ- 20 uals and small employers in the State would not 21 qualify for the premium tax credits, cost-shar- 22 ing reductions, or small business credits under 23 sections 36B of the Internal Revenue Code of 24 1986 or under part I of subtitle E for which 25 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 4 •HR 6538 IH they would otherwise be eligible, the Secretary 1 shall provide for an alternative means by which 2 the aggregate amount of such credits or reduc- 3 tions that would have been paid on behalf of 4 participants in the Exchanges established under 5 this title had the State not received such waiv- 6 er, shall be paid into the Trump Health Free- 7 dom Accounts established under section 223(i) 8 of the Internal Revenue Code of 1986 of eligible 9 residents of the State. 10 ‘‘(B) PAYMENTS TO TRUMP HEALTH FREE- 11 DOM ACCOUNTS.—The Secretary shall pay into 12 the Trump Health Freedom Account of each el- 13 igible resident of a State for which a waiver is 14 in effect for a plan year the amount equal to 15 the total amount for which the resident would 16 have been eligible in premium tax credit 17 amounts under section 36B of the Internal Rev- 18 enue Code of 1986 and cost-sharing reduction 19 amounts under section 1402 for the year, had 20 the State not had such waiver in effect. In de- 21 termining the appropriate payment amount 22 under this subparagraph, the Secretary shall 23 calculate premium tax credit amounts and cost- 24 sharing reduction amounts based on the na- 25 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 5 •HR 6538 IH tional average annual premium amount for a 1 silver tier benchmark plan among States that 2 do not have such waivers in effect for the appli- 3 cable year. The Secretary shall make payments 4 into the Trump Health Freedom Accounts of el- 5 igible residents on a monthly basis, quarterly 6 basis, or in one lump sum at the beginning of 7 the year, at the option of each eligible resident. 8 ‘‘(6) COORDINATED WAIVER PROCESS.—The 9 Secretary shall develop a process for coordinating 10 and consolidating the State waiver processes applica- 11 ble under the provisions of this section, and the ex- 12 isting waiver processes applicable under section 1332 13 and titles XVIII, XIX, and XXI of the Social Secu- 14 rity Act, and any other Federal law relating to the 15 provision of health care items or services. Such proc- 16 ess shall permit a State to submit a single applica- 17 tion for a waiver under any or all of such provisions. 18 ‘‘(7) EXCHANGES.— 19 ‘‘(A) IN GENERAL.—In the case of a State 20 in which a waiver is in effect under this section 21 for a plan year— 22 ‘‘(i) the State may— 23 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 6 •HR 6538 IH ‘‘(I) operate an Exchange estab- 1 lished as described in section 1311(b); 2 or 3 ‘‘(II) allow one or more private 4 entities to run commercial platforms 5 that sell health plans approved by the 6 State insurance commissioner; or 7 ‘‘(ii) if the State does not operate an 8 Exchange as described in clause (i)(I) or 9 allow for one or more commercial plat- 10 forms described in clause (i)(II), the Sec- 11 retary shall operate a Federal Exchange, 12 as described in section 1321(c), provided 13 that any State laws regarding the avail- 14 ability of health plans on, and the oper- 15 ation of, such Exchange shall apply in lieu 16 of any provision under part 1 or part 2 17 that such State has waived. 18 ‘‘(B) APPLICATION PROGRAM INTER- 19 FACE.—The Secretary shall make available to 20 any State that allows for commercial platforms 21 described in subparagraph (A)(i)(II), the appli- 22 cation program interface used for operating 23 Federal and State Exchanges, for use by any 24 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 7 •HR 6538 IH private entity running such a platform under 1 State authority. 2 ‘‘(8) DEFINITIONS.—In this section: 3 ‘‘(A) ELIGIBLE RESIDENT.—The term ‘eli- 4 gible resident’ means, with respect to a State 5 for which a waiver is in effect under this sec- 6 tion, a resident who— 7 ‘‘(i) in the absence of such a waiver in 8 the State, would be eligible for a premium 9 tax credit under section 36B of the Inter- 10 nal Revenue Code of 1986 or a cost-shar- 11 ing reduction under section 1402, if the 12 resident enrolled in a qualified health plan 13 offered on the Exchange of such State; and 14 ‘‘(ii) enrolls in a plan offered on the 15 Exchange described in paragraph (7) for 16 the applicable plan year. 17 ‘‘(B) SECRETARY.—Term ‘Secretary’ 18 means— 19 ‘‘(i) the Secretary of Health and 20 Human Services with respect to waivers re- 21 lating to the provisions described in sub- 22 paragraph (A) through (C) of paragraph 23 (4); and 24 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 8 •HR 6538 IH ‘‘(ii) the Secretary of the Treasury 1 with respect to waivers relating to the pro- 2 visions described in paragraph (4)(D). 3 ‘‘(b) WAIVER PERIOD.—Each waiver under this sec- 4 tion shall be in effect beginning on January 1 of the plan 5 year for which a timely notice is submitted by the State 6 under subsection (a)(2), and continuing until the entity 7 of the State described in subparagraph (A) or (B) of sub- 8 section (a)(3) that submitted the notification under sub- 9 section (a)(2) submits to the Secretary a notification of 10 intent to discontinue participation in the waiver program 11 under this section. 12 ‘‘(c) LIMITATION.—The Secretary may not permit a 13 waiver under this section of any Federal law or require- 14 ment this is not within the authority of the Secretary. 15 ‘‘(d) AVAILABILITY OF PLANS.— 16 ‘‘(1) IN GENERAL.—Any health insurance cov- 17 erage offered in a State for which a waiver under 18 this section is in effect, and authorized by the insur- 19 ance commissioner of the State, shall be made avail- 20 able on, as applicable, the Federal or State Ex- 21 change or commercial platforms described in sub- 22 section (a)(7), of all States for which such a waiver 23 is in effect, subject to the laws of each such State. 24 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 9 •HR 6538 IH ‘‘(2) CHILD-ONLY PLANS.—In any State for 1 which a waiver under this section is in effect, a 2 health insurance issuer may offer a plan in which 3 the only individuals eligible to enroll are individuals 4 who, as of the beginning of a plan year, have not yet 5 attained the age of 21. 6 ‘‘(e) REGULATIONS.—Not later than 1 year after the 7 date of enactment of the More Affordable Care Act, the 8 Secretary of Health and Human Services, in coordination 9 with the Secretary of the Treasury, shall promulgate regu- 10 lations to carry out this section. 11 ‘‘(f) RULE OF CONSTRUCTION REGARDING CON- 12 SUMER PROTECTIONS, INCLUDING THE PRE-EXISTING 13 CONDITION PROTECTION.—Nothing in this section shall 14 be construed to allow a State to waive the requirements 15 of title XXVII of the Public Health Service Act, including 16 sections 2701, 2702, 2703, 2704, 2705, 2708, 2711, 17 2712, and 2718 of such Act.’’. 18 SEC. 3. TRUMP HEALTH FREEDOM ACCOUNTS. 19 (a) IN GENERAL.—Section 223 of the Internal Rev- 20 enue Code of 1986 is amended by adding at the end the 21 following new subsection: 22 ‘‘(i) TRUMP HEALTH FREEDOM ACCOUNTS.—For 23 purposes of this section— 24 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 10 •HR 6538 IH ‘‘(1) IN GENERAL.—In the case of a Trump 1 Health Freedom Account, this section shall be ap- 2 plied as provided in paragraphs (3) through (8). 3 ‘‘(2) TRUMP HEALTH FREEDOM ACCOUNT.— 4 The term ‘Trump Health Freedom Account’ means 5 a health savings account (determined as provided in 6 this subsection) established by or on behalf of an in- 7 dividual residing in a State for which a waiver under 8 section 1335 of the Patient Protection and Afford- 9 able Care Act is in effect which receives deposits of 10 amounts transferred to the individual pursuant to 11 section 1335(a)(5) of such Act. 12 ‘‘(3) ELIGIBLE INDIVIDUAL.—Any individual 13 covered under a health plan authorized to be made 14 available on an Exchange by section 1335(d) of such 15 Act shall be treated as an eligible individual. 16 ‘‘(4) TREATMENT OF TRANSFERRED CONTRIBU- 17 TIONS.—Amounts transferred to a Trump Health 18 Freedom Account pursuant to section 1335(a)(5) of 19 such Act shall not be taken into account in deter- 20 mining the deduction allowed by subsection (a). 21 ‘‘(5) HEALTH INSURANCE MAY BE PURCHASED 22 FROM ACCOUNT.—Subsection (d)(2)(B) shall not 23 apply. 24 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 11 •HR 6538 IH ‘‘(6) ACCOUNT MUST BE ONLY HSA OF INDI- 1 VIDUAL.— 2 ‘‘(A) IN GENERAL.—An individual who has 3 a Trump Health Freedom Account shall not be 4 treated as an eligible individual with respect to 5 any health savings account other than such 6 Trump Health Freedom Account. 7 ‘‘(B) ROLLOVER OF EXISTING ACCOUNT 8 PERMITTED.—An individual on whose behalf a 9 Trump Health Freedom Account is established 10 may roll over the balance of any other health 11 savings account of the individual to such 12 Trump Health Freedom Account according to 13 the rules of subsection (f)(5). 14 ‘‘(7) NO ROLLOVERS PERMITTED.—Except as 15 provided in paragraph (6)(B), subsection (f)(5) shall 16 not apply and no amount shall be contributed from 17 a Trump Health Freedom Account to any health 18 savings account other than a Trump Health Free- 19 dom Account. 20 ‘‘(8) RESTRICTION ON USE OF AMOUNTS.—No 21 amounts in a Trump Health Freedom Account may 22 be used— 23 ‘‘(A) to pay premiums for a health plan 24 that covers— 25 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 12 •HR 6538 IH ‘‘(i) gender transition procedures, or 1 ‘‘(ii) abortion services; or 2 ‘‘(B) to pay for any service described in 3 clause (i) or (ii) of subparagraph (A). 4 ‘‘(9) DEFINITIONS.—For purposes of paragraph 5 (8)— 6 ‘‘(A) GENDER TRANSITION PROCEDURE.— 7 ‘‘(i) IN GENERAL.—The term ‘gender 8 transition procedure’ means any hormonal 9 or surgical intervention for the purpose of 10 gender transition, including— 11 ‘‘(I) gonadotropin-releasing hor- 12 mone (GnRH) agonists or other pu- 13 berty-blocking or suppressing drugs to 14 stop or delay normal puberty; 15 ‘‘(II) testosterone, estrogen, pro- 16 gesterone, or other androgens to an 17 individual at doses that are 18 supraphysiologic to what would nor- 19 mally be produced endogenously in a 20 healthy individual of the same age 21 and sex; 22 ‘‘(III) castration; 23 ‘‘(IV) orchiectomy; 24 ‘‘(V) scrotoplasty; 25 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 13 •HR 6538 IH ‘‘(VI) implantation of erection or 1 testicular prostheses; 2 ‘‘(VII) vasectomy; 3 ‘‘(VIII) hysterectomy; 4 ‘‘(IX) oophorectomy; 5 ‘‘(X) ovariectomy; 6 ‘‘(XI) reconstruction of the fixed 7 part of the urethra with or without a 8 metoidioplasty or a phalloplasty; 9 ‘‘(XII) metoidioplasty; 10 ‘‘(XIII) penectomy; 11 ‘‘(XIV) phalloplasty; 12 ‘‘(XV) vaginoplasty; 13 ‘‘(XVI) clitoroplasty; 14 ‘‘(XVII) vaginectomy; 15 ‘‘(XVIII) vulvoplasty; 16 ‘‘(XIX) reduction 17 thyrochondroplasty; 18 ‘‘(XX) chondrolaryngoplasty; 19 ‘‘(XXI) mastectomy; 20 ‘‘(XXII) tubal ligation; 21 ‘‘(XXIII) sterilization; 22 ‘‘(XXIV) any plastic, cosmetic, or 23 aesthetic surgery that feminizes or 24 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 14 •HR 6538 IH masculinizes the facial or other phys- 1 iological features of an individual; 2 ‘‘(XXV) any placement of chest 3 implants to create feminine breasts; 4 ‘‘(XXVI) any placement of fat or 5 artificial implants in the gluteal re- 6 gion; 7 ‘‘(XXVII) augmentation 8 mammoplasty; 9 ‘‘(XXVIII) liposuction; 10 ‘‘(XXIX) lipofilling; 11 ‘‘(XXX) voice surgery; 12 ‘‘(XXXI) hair reconstruction; 13 ‘‘(XXXII) pectoral implants; and 14 ‘‘(XXXIII) the removal of any 15 otherwise healthy or non-diseased 16 body part or tissue. 17 ‘‘(ii) EXCLUSIONS.—The term ‘gender 18 transition procedure’ does not include the 19 following when furnished to an individual 20 by a health care provider with the consent 21 of such individual or, if applicable, such in- 22 dividual’s parents or legal guardian: 23 ‘‘(I) Services to individuals born 24 with a medically verifiable disorder of 25 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 15 •HR 6538 IH sex development, including an indi- 1 vidual with external sex characteris- 2 tics that are irresolvably ambiguous, 3 such as an individual born with 46 4 XX chromosomes with virilization, an 5 individual born with 46 XY chro- 6 mosomes with undervirilization, or an 7 individual born having both ovarian 8 and testicular tissue. 9 ‘‘(II) Services provided when a 10 physician has otherwise diagnosed a 11 disorder of sexual development in 12 which the physician has determined 13 through genetic or biochemical testing 14 that the individual does not have nor- 15 mal sex chromosome structure, sex 16 steroid hormone production, or sex 17 steroid hormone action for a healthy 18 individual of the same sex and age. 19 ‘‘(III) The treatment of any in- 20 fection, injury, disease, or disorder 21 that has been caused by or exacer- 22 bated by the performance of gender 23 transition procedures, whether or not 24 the gender transition procedure was 25 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 16 •HR 6538 IH performed in accordance with State 1 and Federal law or whether or not 2 funding for the gender transition pro- 3 cedure is permissible under this sec- 4 tion. 5 ‘‘(IV) Any procedure undertaken 6 because the individual suffers from a 7 physical disorder, physical injury, or 8 physical illness (but not mental, be- 9 havioral, or emotional distress or a 10 mental, behavioral, or emotional dis- 11 order) that would, as certified by a 12 physician, place the individual in im- 13 minent danger of death or impairment 14 of major bodily function, unless the 15 procedure is performed. 16 ‘‘(V) Puberty suppression or 17 blocking prescription drugs for the 18 purpose of normalizing puberty for a 19 minor experiencing precocious pu- 20 berty. 21 ‘‘(VI) Male circumcision. 22 ‘‘(B) GENDER TRANSITION.—The term 23 ‘gender transition’ means the process in which 24 an individual goes from identifying with or pre- 25 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 17 •HR 6538 IH senting as his or her sex to identifying with or 1 presenting a self-proclaimed identity that does 2 not correspond with or is different from his or 3 her sex, and may be accompanied with social, 4 legal, or physical changes. 5 ‘‘(C) SEX.—The term ‘sex’, when referring 6 to an individual’s sex, means to refer to either 7 male or female, as biologically determined. 8 ‘‘(D) FEMALE.—The term ‘female’, when 9 used to refer to a natural person, means an in- 10 dividual who naturally has, had, will have, or 11 would have, but for a congenital anomaly, his- 12 torical accident, or intentional or unintentional 13 disruption, the reproductive system that at 14 some point produces, transports, and utilizes 15 eggs for fertilization. 16 ‘‘(E) MALE.—The term ‘male’, when used 17 to refer to a natural person, means an indi- 18 vidual who naturally has, had, will have, or 19 would have, but for a congenital anomaly, his- 20 torical accident, or intentional or unintentional 21 disruption, the reproductive system that at 22 some point produces, transports, and utilizes 23 sperm for fertilization. 24 ‘‘(F) ABORTION SERVICES.— 25 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 18 •HR 6538 IH ‘‘(i) IN GENERAL.—The term ‘abor- 1 tion services’ means— 2 ‘‘(I) drugs or procedures used 3 with the primary intent to end the life 4 of the human being in the womb, 5 ‘‘(II) pre-viable delivery not de- 6 scribed in clause (ii), and 7 ‘‘(III) post-viable delivery with 8 intentional death of the fetus. 9 ‘‘(ii) EXCLUSIONS.—Such term does 10 not include— 11 ‘‘(I) separation of the mother 12 and her embryo or fetus to prevent 13 the mother’s death or immediate irre- 14 versible bodily harm, which cannot be 15 mitigated in any other way, 16 ‘‘(II) treatment of ectopic or 17 molar pregnancy, 18 ‘‘(III) treatment of miscarriage, 19 or 20 ‘‘(IV) any service described in 21 clause (i) in the case of a pregnancy 22 which is the result of an act of rape 23 or incest.’’. 24 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 19 •HR 6538 IH (b) EFFECTIVE DATE.—The amendment made by 1 this section shall apply to taxable years beginning after 2 December 31, 2025. 3 SEC. 4. CREDIT FOR EMPLOYEE INSURANCE EXPENSES OF 4 SMALL EMPLOYERS IN WAIVER STATE. 5 (a) IN GENERAL.—Subsection (g) of section 45R of 6 the Internal Revenue Code of 1986 is amended to read 7 as follows: 8 ‘‘(g) CREDIT FOR SMALL EMPLOYERS IN WAIVER 9 STATE.—For purposes of this section— 10 ‘‘(1) IN GENERAL.—In the case of an eligible 11 small employer (determined with the modifications 12 provided in this subsection) located in a State for 13 which a waiver under section 1335 of the Patient 14 Protection and Affordable Care Act is in effect, this 15 section shall be applied as provided in paragraphs 16 (2) through (7). 17 ‘‘(2) HEALTH INSURANCE CREDIT AMOUNT.— 18 Subsection (b) shall be applied by substituting ‘50 19 percent’ for ‘50 percent (35 percent in the case of 20 a tax-exempt eligible small employer)’. 21 ‘‘(3) QUALIFIED PLANS.—Subsections (b) and 22 (d)(4) shall be applied by treating any health plan 23 authorized to be made available on an Exchange in 24 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 20 •HR 6538 IH such State by section 1335(d) of such Act as a 1 qualified health plan offered through an Exchange. 2 ‘‘(4) PHASEOUT NOT TO APPLY.—Subsection 3 (c) shall not apply. 4 ‘‘(5) ELIGIBLE SMALL EMPLOYER.—Subsection 5 (d) shall be applied— 6 ‘‘(A) by substituting ‘50’ for ‘25’ in para- 7 graph (1)(A) thereof, and 8 ‘‘(B) without regard to subparagraph (B) 9 of paragraph (1) thereof. 10 ‘‘(6) EMPLOYEE.—Subsection (e)(1)(A) shall be 11 applied without regard to clause (i) thereof. 12 ‘‘(7) CREDIT PERIOD.—Subsection (e)(2) shall 13 not apply, and the credit period with respect to any 14 such employer shall be the period consisting of the 15 1st taxable year in which the employer (or any pred- 16 ecessor) offers 1 or more qualified health plans to its 17 employees, and any subsequent taxable year. 18 ‘‘(8) TAX-EXEMPT RULES NOT TO APPLY.— 19 Subsection (f) shall not apply.’’. 20 (b) EFFECTIVE DATE.—The amendment made by 21 this section shall apply to taxable years beginning after 22 December 31, 2025. 23 VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB 21 •HR 6538 IH SEC. 5. PROMOTING BETTER PRICE REPORTING AND OUT- 1 COMES DATA. 2 Not later than 90 days after the date of enactment 3 of this Act, the Secretary of Health and Human Services, 4 in coordination with the Secretary of the Treasury and 5 the Secretary of Labor, shall update all regulations and 6 guidance issued by such secretaries pursuant to Executive 7 Order 13877 (84 Fed. Reg. 30849 (June 24, 2019)), in- 8 cluding by— 9 (1) requiring the disclosure of the actual prices 10 of items and services, not price estimates; 11 (2) issuing updated guidance or regulations en- 12 suring pricing information is standardized and easily 13 comparable across hospitals and health plans; 14 (3) issuing guidance or proposed regulatory ac- 15 tion updating enforcement policies designed to en- 16 sure compliance with the transparent reporting of 17 complete, accurate, and meaningful data; and 18 (4) requiring the public reporting of outcomes 19 data by providers. 20 Æ VerDate Sep 11 2014 03:29 Dec 23, 2025 Jkt 069200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6301 E:\BILLS\H6538.IH H6538 kjohnson on DSK7ZCZBW3PROD with $$_JOB