Health Care Fairness for All Act

Bill Number

H.R. 3080

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-04-29: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, 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.

Last Updated

2025-07-21T19:44:15Z

AI-Generated Summary

Summary of H.R. 3080: Health Care Fairness for All Act

Purpose

The legislation aims to promote health care fairness and affordability for all Americans by eliminating mandates from the Affordable Care Act (ACA, or Public Law 111-148), providing states with flexible options for affordable coverage, retaining key consumer protections, and encouraging the use of reformed health savings accounts (HSAs) for health insurance and long-term care. It seeks to replace ACA subsidies with a new universal tax credit system while allowing states to maintain or adapt ACA-like coverage if desired.

Key Provisions

• Repeal of Mandates (Title I, Subtitle A): Ends the individual mandate to buy health insurance (effective after December 31, 2024) and the employer mandate to provide coverage (effective 30 days after enactment). Removes related tax penalties and reporting requirements.
• Limitation on Federal Health Plan Requirements (Title I, Subtitle B): Rolls back most ACA rules on health plans to pre-ACA standards, but keeps essential consumer protections such as no lifetime or annual benefit limits (except for limited-benefit plans), dependent coverage up to age 26, guaranteed availability and renewability, bans on pre-existing condition exclusions, and non-discrimination based on health status. Introduces a late enrollment penalty (up to 20% premium increase) for those without 12 months of continuous coverage, with state waiver options. Eliminates the federal essential health benefits mandate but allows states to enforce it. Permits states to regulate markets outside ACA Exchanges, including default enrollment in basic high-deductible plans paired with Roth HSAs (with opt-out). Expands access to short-term limited-duration insurance and makes COVID-era telehealth flexibilities permanent.
• Health Insurance Tax Benefit (Title I, Subtitle C): Creates a new refundable tax credit (Section 36C of the Internal Revenue Code) starting in 2026 for "qualified residents" (U.S. citizens, nationals, or lawful residents) with "creditable coverage" (broad health insurance meeting basic standards). The credit is up to $4,000 per adult ($2,000 per child) annually, adjustable for inflation, limited to HSA contributions or premiums paid. Excludes coverage with non-excepted abortions (e.g., elective abortions, but allows separate purchase). Coordinates with employer subsidies; excess employer benefits become taxable. Disqualifies recipients from ACA premium tax credits. Allocates 25% of unused credits to states for indigent health care or disproportionate share hospital payments. Allows Medicaid enrollees to opt for private plans with state HSA deposits. Requires annual HHS reports on credit adequacy.
• Medicare Reforms (Title I, Subtitle D): Repeals ACA restrictions on physician-owned hospitals; prohibits using an "inpatient-only" list to deny outpatient designations; promotes site-neutral payments (equalizing rates for same services regardless of location, effective 2026); allows Medicare Advantage plans to contribute to Roth HSAs for chronically ill enrollees; extends "Acute Hospital Care at Home" waivers permanently with new safety rules.
• Improved Health Savings Accounts (Title II): Transitions HSAs to non-deductible "Roth HSAs" (effective 2026), with tax-free growth and withdrawals for qualified medical expenses (up to $5,000 individual/$10,000 family annually, plus catch-up for those 55+). Bans new deductible HSA contributions after 2025 (with exceptions). Eliminates the above-the-line medical expense deduction (except long-term care premiums). Treats Roth HSAs as inheritable without tax penalties. Allows direct primary care arrangements (prepaid physician access) as qualified expenses, exempt from insurance regulations.
• State Flexibility in Insurance Regulation (Title III): Grants states broad authority to regulate non-Exchange markets, including allowing employer reimbursements for individual policies without group plan rules, association health plans, and high-risk pools.
• Medicaid Payment Reform (Title IV): Replaces traditional Medicaid funding with a reformed system (effective July 1, 2022) based on per-beneficiary amounts for four categories (elderly, blind/disabled, children, other adults), adjusted for risk, geography, and inflation (using GDP plus 1%). Includes a 10-year transition to narrow state spending variations around the national average. Adds chronic care quality bonuses (1-10% of payments) for top-performing states. Allows states to receive Medicare payments for full-benefit dual eligibles (those on both Medicare and Medicaid) and provide those services. Maintains state matching requirements (at least 25% federal share) with limits on eligibility above 100% poverty (exceptions for certain groups). Excludes certain payments (e.g., territories, vaccines) from the new system.
• Price Transparency (Title V): Codifies the 2019 HHS rule requiring hospitals to publicly disclose standard charges for services, making it statutory law.

Significant Changes to Existing Law

• ACA Overhaul: Repeals core mandates and subsidies, reverting much of the law to pre-2010 standards while preserving select protections. Ends essential health benefits as a federal requirement and ACA reinsurance contributions.
• Tax Code Shifts: Introduces Roth HSAs as the primary vehicle for tax-advantaged savings (replacing traditional HSAs), phases out medical deductions, and creates a flat universal credit (Section 36C) instead of income-based ACA credits (Section 36B).
• Medicaid Restructuring: Moves from open-ended matching grants to capped, beneficiary-based block grants with risk adjustments and quality incentives, potentially limiting federal spending growth.
• Medicare Adjustments: Removes ACA limits on hospital ownership, enforces site-neutral payments to cut costs (e.g., off-campus outpatient departments), and integrates HSAs.
• Reporting and Enforcement: Eliminates ACA employer reporting on premiums/benefits; requires new data sharing for tax credits and Medicaid audits.

Potential Impacts

• Government Agencies: HHS, Treasury, and CMS face implementation burdens, including new tax credit administration, risk adjustment models, and Medicaid payment calculations (with biannual updates). Could reduce federal Medicaid spending over time via caps but increase short-term administrative costs. No direct international relations impacts noted.
• Citizens: Offers more insurance choices (e.g., short-term plans, HSAs) and potential affordability via tax credits, but risks coverage gaps for those opting out or facing late penalties. Low-income individuals may benefit from state indigent funds; Medicaid enrollees gain private plan options but face eligibility caps. Enhanced telehealth and home care could improve access, especially for rural or chronically ill.
• Overall System: Promotes market-based approaches, potentially lowering premiums through competition but increasing out-of-pocket costs via high-deductible plans. Price transparency may empower consumers to shop for care.

Main Stakeholders Affected

• Individuals and Families: Qualified residents eligible for tax credits; Medicaid beneficiaries (especially dual eligibles and those with chronic conditions); those without continuous coverage facing penalties.
• Employers: Relieved of mandates and reporting; can reimburse individual premiums tax-free via HRAs.
• States: Gain flexibility in markets and Medicaid (e.g., default enrollment, waivers); must match funds and report data for bonuses.
• Health Insurers and Providers: Insurers benefit from expanded short-term/limited-benefit options but must comply with risk adjustment and transparency; hospitals face site-neutral payments and ownership expansions; physicians gain from direct care exemptions and telehealth.
• Hospitals and Medicare Enrollees: Physician-owned facilities revived; chronically ill in Medicare Advantage get HSA boosts; home care waivers extended.

Notable Legal, Constitutional, or Political Implications

• Legal: Integrates changes across the Public Health Service Act, ERISA, Internal Revenue Code, and Social Security Act, with coordination rules for conflicting provisions. Codifies existing rules (e.g., price transparency) and sunsets others (e.g., ACA reinsurance). Allows states to waive Exchange rules but maintains HIPAA privacy and COBRA. Abortion exclusions in credits may invite challenges under equal protection or reproductive rights laws.
• Constitutional: Builds on prior ACA litigation by repealing mandates (avoiding individual mandate tax upheld in NFIB v. Sebelius), but new credit restrictions could raise Commerce Clause or equal protection questions if seen as coercive. State flexibility enhances federalism principles.
• Political: Shifts policy from government mandates to tax incentives and state control, potentially polarizing debates on ACA remnants. Quality bonuses incentivize chronic care improvements, but spending caps may spark concerns over access for vulnerable groups. Requires congressional reports and HHS guidance for smooth rollout.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Sessions, Pete [R-TX-17]

Recent Actions

• 2025-04-29: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, 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.
• 2025-04-29: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, 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.
• 2025-04-29: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, 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.
• 2025-04-29: Introduced in House
• 2025-04-29: Introduced in House

Bill Versions

• Health Care Fairness for All Act — issued 2025-04-29 — PDF (117 pages)