Healthcare (Insurance)

This bill mandates a study by the Government Accountability Office (GAO) to examine how specific contract clauses in health insurance agreements affect competition and costs. It focuses on "anti-steering" clauses (restricting insurers from directing patients to lower-cost providers), "anti-tiering" clauses (blocking tiered provider networks), "all-or-nothing" clauses (forcing inclusion of all providers), and "gag" clauses (preventing price transparency). The study will assess these clauses' impact on healthcare consolidation, consumer prices, access, and whether federal agencies have sufficient resources to enforce antitrust laws against them. The findings must be reported to relevant congressional committees within 18 months of the bill's enactment. This is a procedural study - no immediate policy changes are implemented by the bill itself.

This bill extends the temporary enhanced premium tax credits for health insurance under the Affordable Care Act through 2028, instead of ending in 2026. It directly affects individuals purchasing health insurance through state or federal marketplaces who qualify for these credits based on income (up to 400% of the federal poverty level). The key change updates specific dates in tax law to align the credit period with 2028, while maintaining the same income eligibility rules. The extension applies to tax years beginning after December 31, 2025.

S 2035, the "Protect IVF Act," establishes federal rights to access and provide fertility treatment, including IVF, under widely accepted medical standards defined by the American Society for Reproductive Medicine. It directly affects patients seeking fertility care, health care providers offering IVF services, health insurance issuers covering such care, and manufacturers of fertility-related drugs or devices. The bill preempts state laws that restrict IVF access in ways inconsistent with medical standards - such as mandating unnecessary procedures, limiting telemedicine, or imposing discriminatory barriers - and allows federal court enforcement against violating state actions. This focuses on protecting existing access rather than creating new benefits or altering insurance coverage requirements.

HR 2062 would allow taxpayers to deduct membership fees and medical expenses paid through health care sharing ministries (HCSMs) as medical expenses on their federal tax returns, similar to other health costs. It specifically adds HCSM membership to the list of deductible medical expenses under Internal Revenue Code Section 213(d)(1) and clarifies that HCSMs are not treated as health insurance under Section 7702C. This change directly affects individuals enrolled in HCSMs, which are faith-based or community-based cost-sharing groups operating outside traditional insurance. The bill would take effect for tax years beginning after December 31, 2025.

The MORE Savings Act eliminates copays and deductibles for opioid treatment under Medicare, private health plans, and Medicaid. It requires Medicare beneficiaries to have no out-of-pocket costs for opioid treatment drugs, behavioral health services, and recovery support (like peer counseling and transportation). Private health plans must cover these services without cost-sharing starting in 2027, and Medicaid states get a 90% federal match for medication-assisted treatment. The bill directly affects Medicare beneficiaries, private insurance enrollees, and Medicaid recipients seeking opioid use disorder treatment.

This bill modifies how Medicare calculates rebates for certain drugs to potentially lower costs for beneficiaries. It changes the reference year for rebate calculations from 2021 back to 2016 for both Medicare Part B (outpatient drugs) and Part D (prescription drug coverage) programs. The bill also adjusts how drug units are counted for rebates, excluding units paid for through state Medicaid programs or other existing rebate programs. These changes apply to Part B rebates starting January 2026 and Part D rebates starting October 2025. The policy directly affects drug manufacturers who pay Medicare rebates and impacts Medicare beneficiaries through potential cost reductions in covered drugs.

HR 6575, the CommonGround for Affordable Health Care Act, extends enhanced premium tax credits for health insurance through 2026, directly benefiting millions of lower and middle-income Americans purchasing coverage through the ACA marketplace. The bill modifies income thresholds for premium subsidies, creating new income tiers that maintain or increase financial assistance for households earning up to 1,000% of the poverty level. It includes provisions to prevent fraud in health insurance exchanges by imposing civil penalties on agents and brokers who provide false information, and requires transparency in pharmacy benefit manager contracts to improve drug pricing accountability. The legislation also extends the annual open enrollment period for health insurance exchanges for the 2026 plan year, allowing more time for people to enroll or change coverage.

Health Care Freedom for Patients Act of 2025 This bill allows certain individuals with health savings accounts (HSAs) to receive federal payments. It also restricts payments under Medicaid and the Children's Health Insurance Program (CHIP) regarding certain noncitizens and restricts coverage of gender-transition procedures. Specifically, the bill provides funds for the Department of Health and Human Services to deposit payments into an individual’s HSA during 2026-2027 if the individual has a bronze or catastrophic plan through a health insurance exchange, is between the ages of 18 and 64, and has income up to 700% of the federal poverty level (FPL). Individuals may receive $1,000 or $1,500 annually, depending on age.  The bill also provides funds, beginning in 2027, for cost-sharing reductions for certain individuals who have a silver plan and income up to 250% of the FPL. Beginning in 2027, the bill allows any individual to enroll in a catastrophic plan. Currently, these plans are limited to those under the age of 30 or who have certain exemptions. The bill also reduces the enhanced federal matching rate for the Medicaid expansion population in states that provide any health benefits for individuals who are not qualified aliens under federal law. The bill makes Medicaid and CHIP coverage of individuals while their status is being verified optional and conditions federal payment during this period on verification.  Finally, the bill prohibits exchange plans from covering gender-transition procedures as an essential health benefit and prohibits federal payment under Medicaid and CHIP for these procedures.

The PBM Disclosure Act clarifies that pharmacy benefit managers (PBMs) and third-party administrators (TPAs) must disclose both direct and indirect compensation they receive for managing pharmacy benefits in employer-sponsored health plans. This requirement directly affects PBMs and TPAs that provide pharmacy benefit management services to health plans. The bill mandates the Department of Labor to issue regulations within 180 days of enactment, which will apply to health plan years beginning six months after publication. The law explicitly clarifies an existing ERISA disclosure rule without creating new requirements.

HR 6074 extends two key provisions of the health care premium tax credit through 2028, directly affecting households purchasing health insurance through the marketplace who qualify for these credits. It extends the enhanced amount of the tax credit (currently helping lower-income households) and maintains the rule allowing credits for people with household incomes above 400% of the federal poverty level. The bill updates the expiration dates in the tax code from 2025 to 2028, applying to tax years starting after December 31, 2025. This is a straightforward extension of existing benefits, not a new policy.