HR 3257, the Bridge to Medicaid Act of 2025, would make healthcare more affordable for low-income Americans by reducing out-of-pocket costs for individuals with household incomes at or below 138% of the federal poverty level. The bill extends cost-sharing reductions through 2028, creates special enrollment periods for eligible low-income individuals, and provides additional benefits including non-emergency medical transportation services. It also temporarily expands premium tax credits for 2026-2028 and increases federal Medicaid funding for newly eligible individuals through 2029. The legislation aims to improve access to healthcare for millions of Americans who face financial barriers to coverage.
HR 1300, the PSA Screening for HIM Act, requires health insurance plans and issuers to cover prostate cancer screenings without cost-sharing (like copays or deductibles) for men aged 40+ who are at high risk of prostate cancer. This directly affects African-American men and men with a family history of prostate cancer, as defined by the bill. The law amends existing insurance coverage rules to mandate this specific screening coverage, effective for plan years starting January 1, 2026. It does not change screening guidelines but removes financial barriers to recommended screenings for these high-risk groups.
This bill changes the tax code to allow individuals to deduct payments to health care sharing ministries (HCSMs) as medical expenses, similar to traditional health insurance costs. It directly affects people enrolled in HCSMs - groups that share medical costs among members without being regulated as insurance. The bill adds HCSM membership fees and shared medical expenses to the list of deductible medical costs under Section 213(d)(1) of the tax code and clarifies that HCSMs are not treated as health insurance or health plans. These changes would take effect for tax years starting in 2026.
The Supplemental Benefits for Individuals Act of 2025 amends Section 2791(c)(4) of the Public Health Service Act to include individual health insurance coverage as an "excepted benefit." This change allows health insurance plans purchased directly by individuals (not through employers) to be classified as excepted benefits, meaning they would not need to cover essential health benefits required of standard health plans under the Affordable Care Act. The bill directly affects individuals who buy health insurance on their own by expanding the types of coverage available without meeting full ACA requirements. The key mechanism is a technical update to the definition of excepted benefits in federal law.
S 529, the Capping Prescription Costs Act of 2025, limits how much individuals and families must pay annually out-of-pocket for prescription drugs under most health insurance plans. Starting in 2026, it caps these costs at $2,000 per person or $4,000 per family per year, with automatic annual adjustments using the medical care inflation rate (CPI). This applies to both individual health plans (under the Affordable Care Act) and group health plans (like employer-sponsored coverage), as amended across multiple federal laws. The bill does not change drug prices but directly affects millions of health plan enrollees by setting a maximum annual cost for covered prescriptions.
The POP Act prohibits a single entity from owning both a health insurance company and certain healthcare providers that receive Medicare payments (excluding hospitals, pharmacies, and specific equipment suppliers). It requires violators to sell off either the insurance business or the healthcare provider within 1-2 years, depending on when the ownership began. The law also bars Medicare Advantage and Part D plans from contracting with organizations that violate this rule starting in 2026, treating such contracts as false claims. Enforcement involves the FTC, DOJ, or state attorneys general, with penalties including selling assets and returning revenue to communities.
This bill prohibits federal funds from being used for abortions or health plans covering abortion. It amends the Affordable Care Act to block premium tax credits and cost-sharing reductions for health plans that include abortion coverage (except for rape/incest cases or life-threatening conditions), and requires clear disclosure of abortion coverage and related surcharges in plan materials. The law explicitly exempts abortions performed due to rape, incest, or to preserve a mother's life, and allows separate abortion coverage using non-federal funds. It applies to all federal health programs and ACA marketplace plans, effective for plan years beginning after 2025.
This bill adjusts health insurance subsidies by modifying the premium tax credit structure under the Internal Revenue Code. It replaces previous income thresholds with a sliding-scale formula, increasing subsidies for households earning between 150% and 400% of the federal poverty level - reducing their required premium payments as income rises within these tiers. The changes apply to tax years beginning after December 31, 2025, directly affecting middle-income individuals and families purchasing coverage through health insurance marketplaces. It also repeals specific provisions from a prior reconciliation law related to health care.
This bill would allow states to waive certain Affordable Care Act requirements for health insurance starting in 2026, provided they maintain a high-risk insurance pool. Residents in participating states would receive funds directly into "Trump Health Freedom Accounts" instead of traditional premium tax credits, which could be used to purchase health insurance with restrictions on coverage for gender transition procedures and abortion services. The bill also modifies tax credits for small employers in participating states and requires better price transparency and outcomes reporting from healthcare providers. It would directly affect residents and small businesses in states that choose to participate in the waiver program.
This bill would require health insurance plans that cover obstetrical services to also cover fertility treatment, including procedures like in vitro fertilization, artificial insemination, embryo preservation, and related medications. It applies to private insurance plans, federal employee health benefits, TRICARE, VA benefits, Medicaid programs, and Medicare. The law mandates coverage regardless of whether a patient has been diagnosed with infertility, prohibits cost-sharing exceeding what's applied to other medical services, and requires plans to provide clear notice about the coverage to participants. The goal is to make fertility treatment more accessible and affordable for people who need it.
