Skip to content
Congress·In Committee·3 months ago

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

Also known as: Putting Patients First Healthcare Freedom Act

Legislative Progress

✓ Filed
Review
House
Senate
President

Impacts

Negative Impacts(4)
Medicaid
Hurts
Snap Food Stamps
Hurts
Pregnant
Hurts
Lgbtq
Hurts
Mixed Impacts(9)
Chronic Illness
Neutral
Housing Assistance
Neutral
Child Tax Credit
Neutral
Renter
Neutral
Homeowner
Neutral
Disability Benefits
Neutral
Small Business Owner
Neutral
Gig Worker
Neutral
Union Member
Neutral
Positive Impacts(2)
Retiree
Helps
Medicare
Helps

State Impacts

District of ColumbiaDC
Negative

The bill explicitly applies the federal abortion funding ban to amounts in the District of Columbia budget that are approved by Congress, and it treats the DC government as part of the “Federal Government” for this rule. That could restrict how DC-funded health programs can pay for abortion services or abortion-inclusive health coverage, except for the rape/incest/life exceptions.

Key Points

  • Lets states opt out of parts of the Affordable Care Act starting in 2026 if they run a high-risk pool; people who would get exchange subsidies could get that money paid into a special health account instead.
  • Expands health savings accounts so more people can use them, including many older adults on Medicare; raises how much some people can put in, and allows using the account to buy insurance.
  • Creates or locks in more insurance choices, like employer groups banding together to buy coverage, employers helping workers buy their own plans, and longer-lasting short-term plans.
  • Sets up a federal reinsurance program (2026–2030) to help insurers pay very high medical bills, with the goal of lowering premiums; also includes rules meant to reduce waste and improper sign-ups in exchange plans.
  • Blocks many kinds of federal funding for abortions (with exceptions for rape, incest, or to save the mother’s life) and for many gender transition procedures; also restricts using the new health accounts for those services.
HealthcareTaxesConsumer ProtectionAbortionCivil Rights

Milestones

2 milestones2 actions
Dec 9, 2025House

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.

Dec 9, 2025

Introduced in House

What Happens Next

Projected impacts based on AI analysis

As soon as the bill is enacted; applies to plan years starting Jan 1, 2026 (state must file notice 90+ days before start).

States can start the new “Health Freedom Waiver” for 2026 plan years if they give notice at least 90 days ahead and have a high-risk pool program.

Your state could change exchange rules and how financial help is delivered. Some people could get deposits into a Trump Health Freedom Account instead of premium help that goes straight to an insurer.

Starting with 2026 taxes and plan years after 2025.

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.

Beginning Jan 1, 2026, if enacted; parameters for 2026 must be set within 120 days after enactment.

New reinsurance program for certain off-exchange plans starts (2026–2030), with 2026 payment rules set in the bill ($110k attachment point, 90% payment rate, $300k cap).

If you buy certain off-exchange plans that meet the bill’s rules (including not covering abortion), premiums could be lower than they otherwise would be because insurers get help paying very high claims.

Starting Jan 1, 2026 (if enacted before then; otherwise shortly after enactment as compliance catches up).

Providers and facilities must start telling patients when insurance cost-sharing would be higher than the cash price.

You may be able to ask for the lower cash price instead of using insurance in some situations, helping avoid overpaying.

Plan years beginning on or after Jan 1, 2026.

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.

Within 1 year after enactment.

HHS and Treasury must issue regulations for the new waiver program within 1 year after enactment.

The exact paperwork, timelines, and how payments into Trump Health Freedom Accounts work would become clearer, affecting how smoothly states and families can use the new system.

Applies to plan years starting Jan 1, 2027 (enrollment happens in late 2026).

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.

Plan years beginning on or after Jan 1, 2027.

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.

Plan years beginning on or after Jan 1, 2027.

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.

More than 30 days after enactment.

Abortion coverage disclosure rules change 30+ days after enactment (prominent marketing and surcharge disclosure).

When shopping for plans, people would see clearer up-front information about whether abortion is covered and any separate abortion surcharge, which can reduce surprises.

Related News

2 articles
Breitbart News·3 months ago

Rep. Biggs Unveils Putting Patients First Act to Overhaul Obamacare

Covers the bill’s main components: expanded HSAs (including Medicare Part A), redirecting exchange subsidies into health accounts in opting-in states with high-risk pools, expanded short-term/catastrophic options, and restrictions on abortion and transition funding.

R+
Newsmax·3 months ago

Andy Biggs to Newsmax: GOP Must Back Putting Patients First Act

Interview-focused story describing the bill as a consolidated package expanding health accounts, purchasing groups, transparency, and addressing exchange subsidy structure and improper enrollments; includes Biggs’ framing and rationale.

R+

Source Information

Document Type

Congressional Bill

Official Title

Putting Patients First Healthcare Freedom Act

Bill NumberHR 6512
Congress119th Congress
ChamberHouse of Representatives
Latest ActionReferred 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.

Sponsor

Cosponsors

(2)
R: 2

Analysis generated by AI. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.