House Bill Would Let States Opt Out of ACA, Expand HSAs and Add Insurance Choices

Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and the Judiciary, 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.

Introduced in House

Trump Health Freedom Accounts and many HSA rule changes begin for tax years after Dec. 31, 2025.

People could contribute under the new rules (including many Medicare Part A seniors) and use HSAs more flexibly, including to buy insurance, depending on the exact provision.

Expanded eligibility for catastrophic plans takes effect for 2026 plan years.

If you expect to be ineligible for premium tax credits or cost-sharing help because of your income, you could be allowed to buy a catastrophic plan, which usually has lower premiums but higher costs when you need care.

Beginning with 2027 plan years, open enrollment is set to Nov 1–Dec 15, and income-based special enrollment periods are barred (with some exceptions for life events).

People who miss the window could have a harder time signing up, especially if their income changes during the year. You may need to plan ahead and keep documents ready for special enrollment verification.

Beginning with 2027 plan years, exchanges must verify eligibility for many special enrollments and tighten income verification when tax data isn’t available.

Enrollment could take longer and require more proof (pay stubs, letters, or other documents). Some people could lose or delay subsidies if they can’t verify income quickly.

Beginning with 2027 plan years, exchange essential health benefits cannot include gender transition procedures (as defined by the bill).

Even if a plan is otherwise comprehensive, it could be required not to treat those services as part of the required basic benefits package on the exchange.