Text of US SB 3264 (2025)

II 119TH CONGRESS 1ST SESSION S. 3264 To establish a health freedom waiver program, to promote better price reporting and outcomes, and for other purposes. IN THE SENATE OF THE UNITED STATES NOVEMBER 20, 2025 Mr. SCOTT of Florida introduced the following bill; which was read twice and referred to the Committee on Finance 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 SEC. 2. HEALTH FREEDOM WAIVER PROGRAM. 6 Part 4 of subtitle D of title I of the Patient Protec- 7 tion and Affordable Care Act (42 U.S.C. 18051 et seq.) 8 is amended by adding at the end the following: 9 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 2 •S 3264 IS ‘‘SEC. 1335. HEALTH FREEDOM WAIVER PROGRAM. 1 ‘‘(a) IN GENERAL.— 2 ‘‘(1) WAIVER PROGRAM.—The Secretary shall 3 waive all or any requirements described in para- 4 graph (4), as determined by the applicable State, for 5 plan years beginning on or after January 1, 2026, 6 with respect to health insurance coverage within any 7 State that submits a notification under paragraph 8 (2), provided that the State maintains an invisible 9 high-risk insurance pool or another program de- 10 signed to mitigate risk to insurance premium costs. 11 ‘‘(2) NOTIFICATION.—A State entity described 12 in paragraph (3) desiring a waiver under this section 13 for any plan year beginning on or after January 1, 14 2026, shall notify the Secretary of its intent to par- 15 ticipate in the waiver program with respect to all or 16 any requirements described in paragraph (4). Such 17 notification shall be filed at such time, not later than 18 90 days before the State intends to begin participa- 19 tion in the waiver program, and in such manner as 20 the Secretary may require, and contain such infor- 21 mation as the Secretary may require, including the 22 requirements under paragraph (4) that the State in- 23 tends to waive and evidence that the State maintains 24 a high-risk insurance pool. 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 3 •S 3264 IS ‘‘(3) STATE SUBMISSION.—A notification with 1 respect to a State may be submitted by— 2 ‘‘(A) the governor of the State; or 3 ‘‘(B) the legislature of the State, upon a 4 majority vote by the State legislature. 5 ‘‘(4) REQUIREMENTS.—The requirements de- 6 scribed in this paragraph with respect to health in- 7 surance coverage within the State are as follows: 8 ‘‘(A) Part 1 of subtitle D. 9 ‘‘(B) Part 2 of subtitle D. 10 ‘‘(C) Section 1402. 11 ‘‘(D) Sections 36B and 5000A of the In- 12 ternal Revenue Code of 1986. 13 ‘‘(5) MONEY FOLLOWS THE PERSON.— 14 ‘‘(A) IN GENERAL.—With respect to a 15 State waiver under paragraph (1), under which, 16 due to the structure of the State plan, individ- 17 uals and small employers in the State would not 18 qualify for the premium tax credits, cost-shar- 19 ing reductions, or small business credits under 20 sections 36B of the Internal Revenue Code of 21 1986 or under part I of subtitle E for which 22 they would otherwise be eligible, the Secretary 23 shall provide for an alternative means by which 24 the aggregate amount of such credits or reduc- 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 4 •S 3264 IS tions that would have been paid on behalf of 1 participants in the Exchanges established under 2 this title had the State not received such waiv- 3 er, shall be paid into the Trump Health Free- 4 dom Accounts established under section 223(i) 5 of the Internal Revenue Code of 1986 of eligible 6 residents of the State. 7 ‘‘(B) PAYMENTS TO TRUMP HEALTH FREE- 8 DOM ACCOUNTS.—The Secretary shall pay into 9 the Trump Health Freedom Account of each el- 10 igible resident of a State for which a waiver is 11 in effect for a plan year the amount equal to 12 the total amount for which the resident would 13 have been eligible in premium tax credit 14 amounts under section 36B of the Internal Rev- 15 enue Code of 1986 and cost-sharing reduction 16 amounts under section 1402 for the year, had 17 the State not had such waiver in effect. In de- 18 termining the appropriate payment amount 19 under this subparagraph, the Secretary shall 20 calculate premium tax credit amounts and cost- 21 sharing reduction amounts based on the na- 22 tional average annual premium amount for a 23 silver tier benchmark plan among States that 24 do not have such waivers in effect for the appli- 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 5 •S 3264 IS cable year. The Secretary shall make payments 1 into the Trump Health Freedom Accounts of el- 2 igible residents on a monthly basis, quarterly 3 basis, or in one lump sum at the beginning of 4 the year, at the option of each eligible resident. 5 ‘‘(6) COORDINATED WAIVER PROCESS.—The 6 Secretary shall develop a process for coordinating 7 and consolidating the State waiver processes applica- 8 ble under the provisions of this section, and the ex- 9 isting waiver processes applicable under section 1332 10 and titles XVIII, XIX, and XXI of the Social Secu- 11 rity Act, and any other Federal law relating to the 12 provision of health care items or services. Such proc- 13 ess shall permit a State to submit a single applica- 14 tion for a waiver under any or all of such provisions. 15 ‘‘(7) EXCHANGES.— 16 ‘‘(A) IN GENERAL.—In the case of a State 17 in which a waiver is in effect under this section 18 for a plan year— 19 ‘‘(i) the State may— 20 ‘‘(I) operate an Exchange estab- 21 lished as described in section 1311(b); 22 or 23 ‘‘(II) allow one or more private 24 entities to run commercial platforms 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 6 •S 3264 IS that sell health plans approved by the 1 State insurance commissioner; or 2 ‘‘(ii) if the State does not operate an 3 Exchange as described in clause (i)(I) or 4 allow for one or more commercial plat- 5 forms described in clause (i)(II), the Sec- 6 retary shall operate a Federal Exchange, 7 as described in section 1321(c), provided 8 that any State laws regarding the avail- 9 ability of health plans on, and the oper- 10 ation of, such Exchange shall apply in lieu 11 of any provision under part 1 or part 2 12 that such State has waived. 13 ‘‘(B) APPLICATION PROGRAM INTER- 14 FACE.—The Secretary shall make available to 15 any State that allows for commercial platforms 16 described in subparagraph (A)(i)(II), the appli- 17 cation program interface used for operating 18 Federal and State Exchanges, for use by any 19 private entity running such a platform under 20 State authority. 21 ‘‘(8) DEFINITIONS.—In this section: 22 ‘‘(A) ELIGIBLE RESIDENT.—The term ‘eli- 23 gible resident’ means, with respect to a State 24 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 7 •S 3264 IS for which a waiver is in effect under this sec- 1 tion, a resident who— 2 ‘‘(i) in the absence of such a waiver in 3 the State, would be eligible for a premium 4 tax credit under section 36B of the Inter- 5 nal Revenue Code of 1986 or a cost-shar- 6 ing reduction under section 1402, if the 7 resident enrolled in a qualified health plan 8 offered on the Exchange of such State; and 9 ‘‘(ii) enrolls in a plan offered on the 10 Exchange described in paragraph (7) for 11 the applicable plan year. 12 ‘‘(B) SECRETARY.—Term ‘Secretary’ 13 means— 14 ‘‘(i) the Secretary of Health and 15 Human Services with respect to waivers re- 16 lating to the provisions described in sub- 17 paragraph (A) through (C) of paragraph 18 (4); and 19 ‘‘(ii) the Secretary of the Treasury 20 with respect to waivers relating to the pro- 21 visions described in paragraph (4)(D). 22 ‘‘(b) WAIVER PERIOD.—Each waiver under this sec- 23 tion shall be in effect beginning on January 1 of the plan 24 year for which a timely notice is submitted by the State 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 8 •S 3264 IS under subsection (a)(2), and continuing until the entity 1 of the State described in subparagraph (A) or (B) of sub- 2 section (a)(3) that submitted the notification under sub- 3 section (a)(2) submits to the Secretary a notification of 4 intent to discontinue participation in the waiver program 5 under this section. 6 ‘‘(c) LIMITATION.—The Secretary may not permit a 7 waiver under this section of any Federal law or require- 8 ment this is not within the authority of the Secretary. 9 ‘‘(d) AVAILABILITY OF PLANS.— 10 ‘‘(1) IN GENERAL.—Any health insurance cov- 11 erage offered in a State for which a waiver under 12 this section is in effect, and authorized by the insur- 13 ance commissioner of the State, shall be made avail- 14 able on, as applicable, the Federal or State Ex- 15 change or commercial platforms described in sub- 16 section (a)(7), of all States for which such a waiver 17 is in effect, subject to the laws of each such State. 18 ‘‘(2) CHILD-ONLY PLANS.—In any State for 19 which a waiver under this section is in effect, a 20 health insurance issuer may offer a plan in which 21 the only individuals eligible to enroll are individuals 22 who, as of the beginning of a plan year, have not yet 23 attained the age of 21. 24 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 9 •S 3264 IS ‘‘(e) REGULATIONS.—Not later than 1 year after the 1 date of enactment of the More Affordable Care Act, the 2 Secretary of Health and Human Services, in coordination 3 with the Secretary of the Treasury, shall promulgate regu- 4 lations to carry out this section. 5 ‘‘(f) RULE OF CONSTRUCTION REGARDING CON- 6 SUMER PROTECTIONS, INCLUDING THE PRE-EXISTING 7 CONDITION PROTECTION.—Nothing in this section shall 8 be construed to allow a State to waive the requirements 9 of title XXVII of the Public Health Service Act, including 10 sections 2701, 2702, 2703, 2704, 2705, 2708, 2711, 11 2712, and 2718 of such Act.’’. 12 SEC. 3. TRUMP HEALTH FREEDOM ACCOUNTS. 13 (a) IN GENERAL.—Section 223 of the Internal Rev- 14 enue Code of 1986 is amended by adding at the end the 15 following new subsection: 16 ‘‘(i) TRUMP HEALTH FREEDOM ACCOUNTS.—For 17 purposes of this section— 18 ‘‘(1) IN GENERAL.—In the case of a Trump 19 Health Freedom Account, this section shall be ap- 20 plied as provided in paragraphs (3) through (8). 21 ‘‘(2) TRUMP HEALTH FREEDOM ACCOUNT.— 22 The term ‘Trump Health Freedom Account’ means 23 a health savings account (determined as provided in 24 this subsection) established by or on behalf of an in- 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 10 •S 3264 IS dividual residing in a State for which a waiver under 1 section 1335 of the Patient Protection and Afford- 2 able Care Act is in effect which receives deposits of 3 amounts transferred to the individual pursuant to 4 section 1335(a)(5) of such Act. 5 ‘‘(3) ELIGIBLE INDIVIDUAL.—Any individual 6 covered under a health plan authorized to be made 7 available on an Exchange by section 1335(d) of such 8 Act shall be treated as an eligible individual. 9 ‘‘(4) TREATMENT OF TRANSFERRED CONTRIBU- 10 TIONS.—Amounts transferred to a Trump Health 11 Freedom Account pursuant to section 1335(a)(5) of 12 such Act shall not be taken into account in deter- 13 mining the deduction allowed by subsection (a). 14 ‘‘(5) HEALTH INSURANCE MAY BE PURCHASED 15 FROM ACCOUNT.—Subsection (d)(2)(B) shall not 16 apply. 17 ‘‘(6) ACCOUNT MUST BE ONLY HSA OF INDI- 18 VIDUAL.— 19 ‘‘(A) IN GENERAL.—An individual who has 20 a Trump Health Freedom Account shall not be 21 treated as an eligible individual with respect to 22 any health savings account other than such 23 Trump Health Freedom Account. 24 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 11 •S 3264 IS ‘‘(B) ROLLOVER OF EXISTING ACCOUNT 1 PERMITTED.—An individual on whose behalf a 2 Trump Health Freedom Account is established 3 may roll over the balance of any other health 4 savings account of the individual to such 5 Trump Health Freedom Account according to 6 the rules of subsection (f)(5). 7 ‘‘(7) NO ROLLOVERS PERMITTED.—Except as 8 provided in paragraph (6)(B), subsection (f)(5) shall 9 not apply and no amount shall be contributed from 10 a Trump Health Freedom Account to any health 11 savings account other than a Trump Health Free- 12 dom Account. 13 ‘‘(8) RESTRICTION ON USE OF AMOUNTS.—No 14 amounts in a Trump Health Freedom Account may 15 be used— 16 ‘‘(A) to pay premiums for a health plan 17 that covers— 18 ‘‘(i) gender transition procedures, or 19 ‘‘(ii) abortion services; or 20 ‘‘(B) to pay for any service described in 21 clause (i) or (ii) of subparagraph (A). 22 ‘‘(9) DEFINITIONS.—For purposes of paragraph 23 (8)— 24 ‘‘(A) GENDER TRANSITION PROCEDURE.— 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 12 •S 3264 IS ‘‘(i) IN GENERAL.—The term ‘gender 1 transition procedure’ means any hormonal 2 or surgical intervention for the purpose of 3 gender transition, including— 4 ‘‘(I) gonadotropin-releasing hor- 5 mone (GnRH) agonists or other pu- 6 berty-blocking or suppressing drugs to 7 stop or delay normal puberty; 8 ‘‘(II) testosterone, estrogen, pro- 9 gesterone, or other androgens to an 10 individual at doses that are 11 supraphysiologic to what would nor- 12 mally be produced endogenously in a 13 healthy individual of the same age 14 and sex; 15 ‘‘(III) castration; 16 ‘‘(IV) orchiectomy; 17 ‘‘(V) scrotoplasty; 18 ‘‘(VI) implantation of erection or 19 testicular prostheses; 20 ‘‘(VII) vasectomy; 21 ‘‘(VIII) hysterectomy; 22 ‘‘(IX) oophorectomy; 23 ‘‘(X) ovariectomy; 24 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 13 •S 3264 IS ‘‘(XI) reconstruction of the fixed 1 part of the urethra with or without a 2 metoidioplasty or a phalloplasty; 3 ‘‘(XII) metoidioplasty; 4 ‘‘(XIII) penectomy; 5 ‘‘(XIV) phalloplasty; 6 ‘‘(XV) vaginoplasty; 7 ‘‘(XVI) clitoroplasty; 8 ‘‘(XVII) vaginectomy; 9 ‘‘(XVIII) vulvoplasty; 10 ‘‘(XIX) reduction 11 thyrochondroplasty; 12 ‘‘(XX) chondrolaryngoplasty; 13 ‘‘(XXI) mastectomy; 14 ‘‘(XXII) tubal ligation; 15 ‘‘(XXIII) sterilization; 16 ‘‘(XXIV) any plastic, cosmetic, or 17 aesthetic surgery that feminizes or 18 masculinizes the facial or other phys- 19 iological features of an individual; 20 ‘‘(XXV) any placement of chest 21 implants to create feminine breasts; 22 ‘‘(XXVI) any placement of fat or 23 artificial implants in the gluteal re- 24 gion; 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 14 •S 3264 IS ‘‘(XXVII) augmentation 1 mammoplasty; 2 ‘‘(XXVIII) liposuction; 3 ‘‘(XXIX) lipofilling; 4 ‘‘(XXX) voice surgery; 5 ‘‘(XXXI) hair reconstruction; 6 ‘‘(XXXII) pectoral implants; and 7 ‘‘(XXXIII) the removal of any 8 otherwise healthy or non-diseased 9 body part or tissue. 10 ‘‘(ii) EXCLUSIONS.—The term ‘gender 11 transition procedure’ does not include the 12 following when furnished to an individual 13 by a health care provider with the consent 14 of such individual or, if applicable, such in- 15 dividual’s parents or legal guardian: 16 ‘‘(I) Services to individuals born 17 with a medically verifiable disorder of 18 sex development, including an indi- 19 vidual with external sex characteris- 20 tics that are irresolvably ambiguous, 21 such as an individual born with 46 22 XX chromosomes with virilization, an 23 individual born with 46 XY chro- 24 mosomes with undervirilization, or an 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 15 •S 3264 IS individual born having both ovarian 1 and testicular tissue. 2 ‘‘(II) Services provided when a 3 physician has otherwise diagnosed a 4 disorder of sexual development in 5 which the physician has determined 6 through genetic or biochemical testing 7 that the individual does not have nor- 8 mal sex chromosome structure, sex 9 steroid hormone production, or sex 10 steroid hormone action for a healthy 11 individual of the same sex and age. 12 ‘‘(III) The treatment of any in- 13 fection, injury, disease, or disorder 14 that has been caused by or exacer- 15 bated by the performance of gender 16 transition procedures, whether or not 17 the gender transition procedure was 18 performed in accordance with State 19 and Federal law or whether or not 20 funding for the gender transition pro- 21 cedure is permissible under this sec- 22 tion. 23 ‘‘(IV) Any procedure undertaken 24 because the individual suffers from a 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 16 •S 3264 IS physical disorder, physical injury, or 1 physical illness (but not mental, be- 2 havioral, or emotional distress or a 3 mental, behavioral, or emotional dis- 4 order) that would, as certified by a 5 physician, place the individual in im- 6 minent danger of death or impairment 7 of major bodily function, unless the 8 procedure is performed. 9 ‘‘(V) Puberty suppression or 10 blocking prescription drugs for the 11 purpose of normalizing puberty for a 12 minor experiencing precocious pu- 13 berty. 14 ‘‘(VI) Male circumcision. 15 ‘‘(B) GENDER TRANSITION.—The term 16 ‘gender transition’ means the process in which 17 an individual goes from identifying with or pre- 18 senting as his or her sex to identifying with or 19 presenting a self-proclaimed identity that does 20 not correspond with or is different from his or 21 her sex, and may be accompanied with social, 22 legal, or physical changes. 23 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 17 •S 3264 IS ‘‘(C) SEX.—The term ‘sex’, when referring 1 to an individual’s sex, means to refer to either 2 male or female, as biologically determined. 3 ‘‘(D) FEMALE.—The term ‘female’, when 4 used to refer to a natural person, means an in- 5 dividual who naturally has, had, will have, or 6 would have, but for a congenital anomaly, his- 7 torical accident, or intentional or unintentional 8 disruption, the reproductive system that at 9 some point produces, transports, and utilizes 10 eggs for fertilization. 11 ‘‘(E) MALE.—The term ‘male’, when used 12 to refer to a natural person, means an indi- 13 vidual who naturally has, had, will have, or 14 would have, but for a congenital anomaly, his- 15 torical accident, or intentional or unintentional 16 disruption, the reproductive system that at 17 some point produces, transports, and utilizes 18 sperm for fertilization. 19 ‘‘(F) ABORTION SERVICES.— 20 ‘‘(i) IN GENERAL.—The term ‘abor- 21 tion services’ means— 22 ‘‘(I) drugs or procedures used 23 with the primary intent to end the life 24 of the human being in the womb, 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 18 •S 3264 IS ‘‘(II) pre-viable delivery not de- 1 scribed in clause (ii), and 2 ‘‘(III) post-viable delivery with 3 intentional death of the fetus. 4 ‘‘(ii) EXCLUSIONS.—Such term does 5 not include— 6 ‘‘(I) separation of the mother 7 and her embryo or fetus to prevent 8 the mother’s death or immediate irre- 9 versible bodily harm, which cannot be 10 mitigated in any other way, 11 ‘‘(II) treatment of ectopic or 12 molar pregnancy, 13 ‘‘(III) treatment of miscarriage, 14 or 15 ‘‘(IV) any service described in 16 clause (i) in the case of a pregnancy 17 which is the result of an act of rape 18 or incest.’’. 19 (b) EFFECTIVE DATE.—The amendment made by 20 this section shall apply to taxable years beginning after 21 December 31, 2025. 22 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 19 •S 3264 IS SEC. 4. CREDIT FOR EMPLOYEE INSURANCE EXPENSES OF 1 SMALL EMPLOYERS IN WAIVER STATE. 2 (a) IN GENERAL.—Subsection (g) of section 45R of 3 the Internal Revenue Code of 1986 is amended to read 4 as follows: 5 ‘‘(g) CREDIT FOR SMALL EMPLOYERS IN WAIVER 6 STATE.—For purposes of this section— 7 ‘‘(1) IN GENERAL.—In the case of an eligible 8 small employer (determined with the modifications 9 provided in this subsection) located in a State for 10 which a waiver under section 1335 of the Patient 11 Protection and Affordable Care Act is in effect, this 12 section shall be applied as provided in paragraphs 13 (2) through (7). 14 ‘‘(2) HEALTH INSURANCE CREDIT AMOUNT.— 15 Subsection (b) shall be applied by substituting ‘50 16 percent’ for ‘50 percent (35 percent in the case of 17 a tax-exempt eligible small employer)’. 18 ‘‘(3) QUALIFIED PLANS.—Subsections (b) and 19 (d)(4) shall be applied by treating any health plan 20 authorized to be made available on an Exchange in 21 such State by section 1335(d) of such Act as a 22 qualified health plan offered through an Exchange. 23 ‘‘(4) PHASEOUT NOT TO APPLY.—Subsection 24 (c) shall not apply. 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 20 •S 3264 IS ‘‘(5) ELIGIBLE SMALL EMPLOYER.—Subsection 1 (d) shall be applied— 2 ‘‘(A) by substituting ‘50’ for ‘25’ in para- 3 graph (1)(A) thereof, and 4 ‘‘(B) without regard to subparagraph (B) 5 of paragraph (1) thereof. 6 ‘‘(6) EMPLOYEE.—Subsection (e)(1)(A) shall be 7 applied without regard to clause (i) thereof. 8 ‘‘(7) CREDIT PERIOD.—Subsection (e)(2) shall 9 not apply, and the credit period with respect to any 10 such employer shall be the period consisting of the 11 1st taxable year in which the employer (or any pred- 12 ecessor) offers 1 or more qualified health plans to its 13 employees, and any subsequent taxable year. 14 ‘‘(8) TAX-EXEMPT RULES NOT TO APPLY.— 15 Subsection (f) shall not apply.’’. 16 (b) EFFECTIVE DATE.—The amendment made by 17 this section shall apply to taxable years beginning after 18 December 31, 2025. 19 SEC. 5. PROMOTING BETTER PRICE REPORTING AND OUT- 20 COMES DATA. 21 Not later than 90 days after the date of enactment 22 of this Act, the Secretary of Health and Human Services, 23 in coordination with the Secretary of the Treasury and 24 the Secretary of Labor, shall update all regulations and 25 VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB 21 •S 3264 IS guidance issued by such secretaries pursuant to Executive 1 Order 13877 (84 Fed. Reg. 30849 (June 24, 2019)), in- 2 cluding by— 3 (1) requiring the disclosure of the actual prices 4 of items and services, not price estimates; 5 (2) issuing updated guidance or regulations en- 6 suring pricing information is standardized and easily 7 comparable across hospitals and health plans; 8 (3) issuing guidance or proposed regulatory ac- 9 tion updating enforcement policies designed to en- 10 sure compliance with the transparent reporting of 11 complete, accurate, and meaningful data; and 12 (4) requiring the public reporting of outcomes 13 data by providers. 14 Æ VerDate Sep 11 2014 04:07 Nov 26, 2025 Jkt 069200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6301 E:\BILLS\S3264.IS S3264 kjohnson on DSK7ZCZBW3PROD with $$_JOB