[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6538 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 6538
To establish a health freedom waiver program, to promote better price
reporting and outcomes, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 9, 2025
Mr. Pfluger (for himself, Mr. Bean of Florida, Mrs. Fedorchak, Mr.
Baird, and Mr. Clyde) introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the
Committee on Ways and Means, 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
_______________________________________________________________________
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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``More Affordable Care Act''.
SEC. 2. HEALTH FREEDOM WAIVER PROGRAM.
Part 4 of subtitle D of title I of the Patient Protection and
Affordable Care Act (42 U.S.C. 18051 et seq.) is amended by adding at
the end the following:
``SEC. 1335. HEALTH FREEDOM WAIVER PROGRAM.
``(a) In General.--
``(1) Waiver program.--The Secretary shall waive all or any
requirements described in paragraph (4), as determined by the
applicable State, for plan years beginning on or after January
1, 2026, with respect to health insurance coverage within any
State that submits a notification under paragraph (2), provided
that the State maintains an invisible high-risk insurance pool
or another program designed to mitigate risk to insurance
premium costs.
``(2) Notification.--A State entity described in paragraph
(3) desiring a waiver under this section for any plan year
beginning on or after January 1, 2026, shall notify the
Secretary of its intent to participate in the waiver program
with respect to all or any requirements described in paragraph
(4). Such notification shall be filed at such time, not later
than 90 days before the State intends to begin participation in
the waiver program, and in such manner as the Secretary may
require, and contain such information as the Secretary may
require, including the requirements under paragraph (4) that
the State intends to waive and evidence that the State
maintains a high-risk insurance pool.
``(3) State submission.--A notification with respect to a
State may be submitted by--
``(A) the governor of the State; or
``(B) the legislature of the State, upon a majority
vote by the State legislature.
``(4) Requirements.--The requirements described in this
paragraph with respect to health insurance coverage within the
State are as follows:
``(A) Part 1 of subtitle D.
``(B) Part 2 of subtitle D.
``(C) Section 1402.
``(D) Sections 36B and 5000A of the Internal
Revenue Code of 1986.
``(5) Money follows the person.--
``(A) In general.--With respect to a State waiver
under paragraph (1), under which, due to the structure
of the State plan, individuals and small employers in
the State would not qualify for the premium tax
credits, cost-sharing reductions, or small business
credits under sections 36B of the Internal Revenue Code
of 1986 or under part I of subtitle E for which they
would otherwise be eligible, the Secretary shall
provide for an alternative means by which the aggregate
amount of such credits or reductions that would have
been paid on behalf of participants in the Exchanges
established under this title had the State not received
such waiver, shall be paid into the Trump Health
Freedom Accounts established under section 223(i) of
the Internal Revenue Code of 1986 of eligible residents
of the State.
``(B) Payments to trump health freedom accounts.--
The Secretary shall pay into the Trump Health Freedom
Account of each eligible resident of a State for which
a waiver is in effect for a plan year the amount equal
to the total amount for which the resident would have
been eligible in premium tax credit amounts under
section 36B of the Internal Revenue Code of 1986 and
cost-sharing reduction amounts under section 1402 for
the year, had the State not had such waiver in effect.
In determining the appropriate payment amount under
this subparagraph, the Secretary shall calculate
premium tax credit amounts and cost-sharing reduction
amounts based on the national average annual premium
amount for a silver tier benchmark plan among States
that do not have such waivers in effect for the
applicable year. The Secretary shall make payments into
the Trump Health Freedom Accounts of eligible residents
on a monthly basis, quarterly basis, or in one lump sum
at the beginning of the year, at the option of each
eligible resident.
``(6) Coordinated waiver process.--The Secretary shall
develop a process for coordinating and consolidating the State
waiver processes applicable under the provisions of this
section, and the existing waiver processes applicable under
section 1332 and titles XVIII, XIX, and XXI of the Social
Security Act, and any other Federal law relating to the
provision of health care items or services. Such process shall
permit a State to submit a single application for a waiver
under any or all of such provisions.
``(7) Exchanges.--
``(A) In general.--In the case of a State in which
a waiver is in effect under this section for a plan
year--
``(i) the State may--
``(I) operate an Exchange
established as described in section
1311(b); or
``(II) allow one or more private
entities to run commercial platforms
that sell health plans approved by the
State insurance commissioner; or
``(ii) if the State does not operate an
Exchange as described in clause (i)(I) or allow
for one or more commercial platforms described
in clause (i)(II), the Secretary shall operate
a Federal Exchange, as described in section
1321(c), provided that any State laws regarding
the availability of health plans on, and the
operation of, such Exchange shall apply in lieu
of any provision under part 1 or part 2 that
such State has waived.
``(B) Application program interface.--The Secretary
shall make available to any State that allows for
commercial platforms described in subparagraph
(A)(i)(II), the application program interface used for
operating Federal and State Exchanges, for use by any
private entity running such a platform under State
authority.
``(8) Definitions.--In this section:
``(A) Eligible resident.--The term `eligible
resident' means, with respect to a State for which a
waiver is in effect under this section, a resident
who--
``(i) in the absence of such a waiver in
the State, would be eligible for a premium tax
credit under section 36B of the Internal
Revenue Code of 1986 or a cost-sharing
reduction under section 1402, if the resident
enrolled in a qualified health plan offered on
the Exchange of such State; and
``(ii) enrolls in a plan offered on the
Exchange described in paragraph (7) for the
applicable plan year.
``(B) Secretary.--Term `Secretary' means--
``(i) the Secretary of Health and Human
Services with respect to waivers relating to
the provisions described in subparagraph (A)
through (C) of paragraph (4); and
``(ii) the Secretary of the Treasury with
respect to waivers relating to the provisions
described in paragraph (4)(D).
``(b) Waiver Period.--Each waiver under this section shall be in
effect beginning on January 1 of the plan year for which a timely
notice is submitted by the State under subsection (a)(2), and
continuing until the entity of the State described in subparagraph (A)
or (B) of subsection (a)(3) that submitted the notification under
subsection (a)(2) submits to the Secretary a notification of intent to
discontinue participation in the waiver program under this section.
``(c) Limitation.--The Secretary may not permit a waiver under this
section of any Federal law or requirement this is not within the
authority of the Secretary.
``(d) Availability of Plans.--
``(1) In general.--Any health insurance coverage offered in
a State for which a waiver under this section is in effect, and
authorized by the insurance commissioner of the State, shall be
made available on, as applicable, the Federal or State Exchange
or commercial platforms described in subsection (a)(7), of all
States for which such a waiver is in effect, subject to the
laws of each such State.
``(2) Child-only plans.--In any State for which a waiver
under this section is in effect, a health insurance issuer may
offer a plan in which the only individuals eligible to enroll
are individuals who, as of the beginning of a plan year, have
not yet attained the age of 21.
``(e) Regulations.--Not later than 1 year after the date of
enactment of the More Affordable Care Act, the Secretary of Health and
Human Services, in coordination with the Secretary of the Treasury,
shall promulgate regulations to carry out this section.
``(f) Rule of Construction Regarding Consumer Protections,
Including the Pre-Existing Condition Protection.--Nothing in this
section shall be construed to allow a State to waive the requirements
of title XXVII of the Public Health Service Act, including sections
2701, 2702, 2703, 2704, 2705, 2708, 2711, 2712, and 2718 of such
Act.''.
SEC. 3. TRUMP HEALTH FREEDOM ACCOUNTS.
(a) In General.--Section 223 of the Internal Revenue Code of 1986
is amended by adding at the end the following new subsection:
``(i) Trump Health Freedom Accounts.--For purposes of this
section--
``(1) In general.--In the case of a Trump Health Freedom
Account, this section shall be applied as provided in
paragraphs (3) through (8).
``(2) Trump health freedom account.--The term `Trump Health
Freedom Account' means a health savings account (determined as
provided in this subsection) established by or on behalf of an
individual residing in a State for which a waiver under section
1335 of the Patient Protection and Affordable Care Act is in
effect which receives deposits of amounts transferred to the
individual pursuant to section 1335(a)(5) of such Act.
``(3) Eligible individual.--Any individual covered under a
health plan authorized to be made available on an Exchange by
section 1335(d) of such Act shall be treated as an eligible
individual.
``(4) Treatment of transferred contributions.--Amounts
transferred to a Trump Health Freedom Account pursuant to
section 1335(a)(5) of such Act shall not be taken into account
in determining the deduction allowed by subsection (a).
``(5) Health insurance may be purchased from account.--
Subsection (d)(2)(B) shall not apply.
``(6) Account must be only hsa of individual.--
``(A) In general.--An individual who has a Trump
Health Freedom Account shall not be treated as an
eligible individual with respect to any health savings
account other than such Trump Health Freedom Account.
``(B) Rollover of existing account permitted.--An
individual on whose behalf a Trump Health Freedom
Account is established may roll over the balance of any
other health savings account of the individual to such
Trump Health Freedom Account according to the rules of
subsection (f)(5).
``(7) No rollovers permitted.--Except as provided in
paragraph (6)(B), subsection (f)(5) shall not apply and no
amount shall be contributed from a Trump Health Freedom Account
to any health savings account other than a Trump Health Freedom
Account.
``(8) Restriction on use of amounts.--No amounts in a Trump
Health Freedom Account may be used--
``(A) to pay premiums for a health plan that
covers--
``(i) gender transition procedures, or
``(ii) abortion services; or
``(B) to pay for any service described in clause
(i) or (ii) of subparagraph (A).
``(9) Definitions.--For purposes of paragraph (8)--
``(A) Gender transition procedure.--
``(i) In general.--The term `gender
transition procedure' means any hormonal or
surgical intervention for the purpose of gender
transition, including--
``(I) gonadotropin-releasing
hormone (GnRH) agonists or other
puberty-blocking or suppressing drugs
to stop or delay normal puberty;
``(II) testosterone, estrogen,
progesterone, or other androgens to an
individual at doses that are
supraphysiologic to what would normally
be produced endogenously in a healthy
individual of the same age and sex;
``(III) castration;
``(IV) orchiectomy;
``(V) scrotoplasty;
``(VI) implantation of erection or
testicular prostheses;
``(VII) vasectomy;
``(VIII) hysterectomy;
``(IX) oophorectomy;
``(X) ovariectomy;
``(XI) reconstruction of the fixed
part of the urethra with or without a
metoidioplasty or a phalloplasty;
``(XII) metoidioplasty;
``(XIII) penectomy;
``(XIV) phalloplasty;
``(XV) vaginoplasty;
``(XVI) clitoroplasty;
``(XVII) vaginectomy;
``(XVIII) vulvoplasty;
``(XIX) reduction
thyrochondroplasty;
``(XX) chondrolaryngoplasty;
``(XXI) mastectomy;
``(XXII) tubal ligation;
``(XXIII) sterilization;
``(XXIV) any plastic, cosmetic, or
aesthetic surgery that feminizes or
masculinizes the facial or other
physiological features of an
individual;
``(XXV) any placement of chest
implants to create feminine breasts;
``(XXVI) any placement of fat or
artificial implants in the gluteal
region;
``(XXVII) augmentation mammoplasty;
``(XXVIII) liposuction;
``(XXIX) lipofilling;
``(XXX) voice surgery;
``(XXXI) hair reconstruction;
``(XXXII) pectoral implants; and
``(XXXIII) the removal of any
otherwise healthy or non-diseased body
part or tissue.
``(ii) Exclusions.--The term `gender
transition procedure' does not include the
following when furnished to an individual by a
health care provider with the consent of such
individual or, if applicable, such individual's
parents or legal guardian:
``(I) Services to individuals born
with a medically verifiable disorder of
sex development, including an
individual with external sex
characteristics that are irresolvably
ambiguous, such as an individual born
with 46 XX chromosomes with
virilization, an individual born with
46 XY chromosomes with
undervirilization, or an individual