[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 3389 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 3389
To lower health care costs for Americans.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 9, 2025
Mr. Marshall introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To lower health care costs for Americans.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Lowering Health
Care Costs for Americans Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--GENERAL PROVISIONS
Sec. 101. Minimum monthly premium payments.
Sec. 102. Requiring biometric and ID verification.
Sec. 103. Facilitating enrollment in and payment into Healthcare
Affordability Accounts.
Sec. 104. Healthcare Affordability Accounts.
Sec. 105. Extension of temporary enhanced premium credits.
Sec. 106. Special rules relating to coverage of abortion services.
Sec. 107. Special rules relating to credit for plans covering abortion
services.
Sec. 108. Reporting of health insurance coverage.
Sec. 109. Exclusion of gender transition procedures from coverage under
qualified health plans.
Sec. 110. Funding cost sharing reduction payments.
Sec. 111. Waivers for State innovation.
TITLE II--HOSPITAL TRANSPARENCY REQUIREMENTS
Sec. 201. Strengthening hospital price transparency requirements.
Sec. 202. Increasing price transparency of clinical diagnostic
laboratory tests.
Sec. 203. Imaging transparency.
Sec. 204. Ambulatory surgical center price transparency requirements.
Sec. 205. Strengthening health coverage transparency requirements.
Sec. 206. Increasing group health plan access to health data.
Sec. 207. Oversight of administrative service providers.
Sec. 208. State preemption only in event of conflict.
Sec. 209. Requirement for explanation of benefits.
Sec. 210. Provision of itemized bills.
TITLE I--GENERAL PROVISIONS
SEC. 101. MINIMUM MONTHLY PREMIUM PAYMENTS.
(a) In General.--Section 36B(b) of the Internal Revenue Code of
1986 is amended by adding at the end the following new paragraph:
``(4) Limitation.--Notwithstanding paragraphs (2) and (3),
in no case shall the premium assistance amount with respect to
any coverage month exceed the excess (if any) of the amount
determined under paragraph (2)(A) over--
``(A) in the case of a taxpayer whose household
income (expressed as a percent of the poverty line) is
less than 200 percent, $10,
``(B) in the case of a taxpayer whose household
income (expressed as a percent of the poverty line) is
not less than 200 percent, and less than 300 percent,
$20,
``(C) in the case of a taxpayer whose household
income (expressed as a percent of the poverty line) is
not less than 300 percent, and less than 400 percent,
$30, and
``(D) in the case of a taxpayer whose household
income (expressed as a percent of the poverty line) is
not less than 400 percent, $40.''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after December 31, 2025.
SEC. 102. REQUIRING BIOMETRIC AND ID VERIFICATION.
Section 1411(b)(1) of Patient Protection and Affordable Care Act
(42 U.S.C. 18081(b)(1)) is amended--
(1) in subparagraph (A), by striking ``; and'' and
inserting a semicolon;
(2) by redesignating subparagraph (B) as subparagraph (C);
and
(3) by inserting after subparagraph (A) the following:
``(B) government-issued photo identification for
each enrollee over the age of 18, and any other
documentation as the Administrator of the Centers for
Medicare & Medicaid Services may require for purposes
of enrollment verification; and''.
SEC. 103. FACILITATING ENROLLMENT IN AND PAYMENT INTO HEALTHCARE
AFFORDABILITY ACCOUNTS.
(a) In General.--Section 1311 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031) is amended--
(1) in subsection (b)(1)--
(A) in subparagraph (B), by striking ``and'' at the
end;
(B) by redesignating subparagraph (C) as
subparagraph (D); and
(C) by inserting after subparagraph (B) the
following:
``(C) in the case of plan years beginning after
December 31, 2026, and before January 1, 2032,
facilitates enrollment in Healthcare Affordability
Accounts described in section 223(i) of the Internal
Revenue Code of 1986, for qualified individuals who
purchase qualified health plans and are eligible for
premium tax credits under section 36B; and'';
(2) by adding at the end of subsection (c) the following:
``(8) Enrollment in healthcare affordability accounts.--The
Secretary shall establish a procedure for notifying qualified
individuals who purchase qualified health plans and who are
eligible for a premium tax credit under section 36B of the
Internal Revenue Code of 1986 of the need to enroll in a
Healthcare Affordability Account described in section 223(i) of
such Code, in order to receive such credit, for plan years
beginning after December 31, 2026, and before January 1,
2032.''; and
(3) in subsection (d)(4)(G), by inserting ``, and, for plan
years beginning after December 31, 2026, and before January 1,
2032, make available to any individual qualifying for such a
tax credit, a link to the application on the website of the
Department of the Treasury for enrollment in a Healthcare
Affordability Account described in section 223(i) of the
Internal Revenue Code of 1986'' before the semicolon at the
end.
(b) Payment of Premium Tax Credits Into Healthcare Affordability
Accounts.--Section 1412 of the Patient Protection and Affordable Care
Act (42 U.S.C. 18082) is amended--
(1) in subsection (a)(3)--
(A) by striking ``the Secretary of the Treasury
makes advance payments'' and inserting ``the Secretary
of the Treasury--
``(A) except as provided in subparagraph (B), makes
advance payments'';
(B) by striking the period at the end and inserting
``, and''; and
(C) by adding at the end the following new
subparagraph:
``(B) in the case of a plan year beginning after
December 31, 2026, and before January 1, 2032, makes
advance payments--
``(i) of such premium tax credit into the
Healthcare Affordability Account maintained
under section 223(i) of the Internal Revenue
Code of 1986 for each individual eligible for
such credit; and
``(ii) of such cost-sharing reductions to
the issuers of the qualified health plans in
order to reduce the premiums payable by
individuals eligible for such cost-sharing
reductions.''; and
(2) in subsection (c)(2)--
(A) by striking ``The Secretary'' and inserting
``Except as provided in subparagraph (C), the
Secretary''; and
(B) by adding at the end the following new
subparagraph:
``(C) Payment of premium tax credit into healthcare
affordability accounts.--In the case of plan years
beginning after December 31, 2026, and before January
1, 2031, the Secretary of the Treasury shall make the
advance payment under this section of any premium tax
credit allowed under section 36B of the Internal
Revenue Code of 1986 to the Healthcare Affordability
Account of the applicable individual on a monthly basis
(or such other periodic basis as the Secretary may
provide).''.
SEC. 104. HEALTHCARE AFFORDABILITY 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) Healthcare Affordability Accounts.--For purposes of this
section--
``(1) In general.--In the case of a Healthcare
Affordability Account, this section shall be applied as
provided in paragraphs (3) through (7).
``(2) Healthcare affordability account.--The term
`Healthcare Affordability Account' means a health savings
account, determined as provided in this subsection.
``(3) Treatment of transferred contributions.--Amounts
transferred to a Healthcare Affordability Account pursuant to
section 1412 of the Patient Protection and Affordable Care Act
shall not be taken into account in determining the deduction
allowed by subsection (a).
``(4) Account must be only hsa of individual.--
``(A) In general.--An individual who has a
Healthcare Affordability Account shall not be treated
as an eligible individual with respect to any health
savings account other than such Healthcare
Affordability Account.
``(B) Rollover of existing account permitted.--An
individual on whose behalf a Healthcare Affordability
Account is established may roll over the balance of any
other health savings account of the individual to such
Healthcare Affordability Account according to the rules
of subsection (f)(5).
``(5) No rollovers permitted.--Except as provided in
paragraph (4)(B), subsection (f)(5) shall not apply and no
amount shall be contributed from a Healthcare Affordability
Account to any health savings account other than a Healthcare
Affordability Account.
``(6) Restriction on use of amounts.--No amounts in a
Healthcare Affordability Account may be used to pay for any--
``(A) gender transition procedures, or
``(B) abortion.
``(7) Definitions.--For purposes of paragraph (6)--
``(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
born having both ovarian and testicular
tissue.
``(II) Services provided when a
physician has otherwise diagnosed a
disorder of sexual development in which
the physician has determined through
genetic or biochemical testing that the
individual does not have normal sex
chromosome structure, sex steroid
hormone production, or sex steroid
hormone action for a healthy individual
of the same sex and age.
``(III) The treatment of any
infection, injury, disease, or disorder
that has been caused by or exacerbated
by the performance of gender transition
procedures, whether or not the gender
transition procedure was performed in
accordance with State and Federal law
or whether or not funding for the
gender transition procedure is
permissible under this section.
``(IV) Any procedure undertaken
because the individual suffers from a
physical disorder, physical injury, or
physical illness (but not mental,
behavioral, or emotional distress or a
mental, behavioral, or emotional
disorder) that would, as certified by a
physician, place the individual in
imminent danger of death or impairment
of major bodily function, unless the
procedure is performed.
``(V) Puberty suppression or
blocking prescription drugs for the
purpose of normalizing puberty for a
minor experiencing precocious puberty.
``(VI) Male circumcision.
``(B) Gender transition.--The term `gender
transition' means the process in which an individual
goes from identifying with or presenting as his or her
sex to identifying with or presenting a self-proclaimed
identity that does not correspond with or is different
from his or her sex, and may be accompanied with
social, legal, or physical changes.
``(C) Sex.--The term `sex', when referring to an
individual's sex, means to refer to either male or
female, as biologically determined.
``(D) Female.--The term `female', when used to
refer to a natural person, means an individual who
naturally has, had, will have, or would have, but for a
congenital anomaly, histo