Health Share Transparency Act of 2025

Bill Number

H.R. 3103

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-04-30: Referred to the House Committee on Energy and Commerce.

Last Updated

2025-05-21T14:01:25Z

AI-Generated Summary

Purpose of the Legislation

The Health Share Transparency Act of 2025 aims to increase transparency for health care sharing ministries (HCSMs), which are nonprofit organizations where members pool funds to share medical costs based on shared religious beliefs. Unlike traditional health insurance, HCSMs are not guaranteed to cover claims. The bill requires HCSMs to disclose financial, operational, and coverage details to regulators, prospective members, and current members to help people make informed decisions and protect against misleading practices.

Key Provisions

• Annual Reporting to Regulators: HCSMs must submit information annually to the Secretary of Health and Human Services (HHS), the IRS Commissioner, and the Director of the Consumer Financial Protection Bureau (CFPB). This includes:
• Financial reserves held by the ministry.
• Ratio of member contributions spent on administrative and other non-claim costs (referencing medical loss ratio standards from existing law).
• Number of enrollees, total payments from members, total claims paid, average out-of-pocket costs, enrollment locations by state and county, claim denial percentage, contact information, contracted health providers, and average claim reimbursement time.
• HHS must publish this data on a public website.

• Disclosures to Members and Prospective Enrollees: HCSMs must provide clear information before enrollment and ongoing to members, covering:
• How to file complaints or appeal coverage decisions, including disclaimers that appeals are limited to the ministry itself and may involve mandatory arbitration (a process where disputes are resolved by a neutral third party instead of court).
• No guarantee of reimbursement (unlike insurance), any lifetime caps on sharing, average out-of-pocket expenses, average annual membership fees, comparison of claims paid versus member cost-sharing, lists of non-reimbursable items/services and conditions for denial, and other claim requirements.
• Disclosures must be prominent, available in multiple languages, provided immediately before enrollment, and in at least 14-point font (or read aloud for phone enrollments).

• Requirements for Enrollment Entities: HCSMs cannot pay or contract with brokers or other entities to enroll members unless those entities inform potential enrollees about:
• Available tax credits for buying regulated health insurance through ACA marketplaces.
• Eligibility for government programs like Medicaid (for low-income individuals) or Medicare (for seniors or disabled people).
• Differences in required benefits and cost protections under insurance versus HCSMs.
• That HCSMs are not insurance and benefits are not guaranteed.

• Enforcement and Oversight:
• HHS can impose civil monetary penalties up to $100 per day per affected individual for violations, with procedures similar to existing health plan penalty rules (e.g., notice, hearings, and appeals).
• The Federal Trade Commission (FTC) must semi-annually (January 1 and July 1) publish and share with HHS and IRS: the number and categories of consumer complaints about HCSMs, plus details on the ministries involved (e.g., ownership and leadership). The first report is due 90 days after enactment.

• Definitions: HHS can define terms related to HCSMs to ensure consistent application.

Significant Changes to Existing Law

This bill adds a new Part F to Title XXVII of the Public Health Service Act (which governs health insurance rules under the Affordable Care Act, or ACA). Previously, HCSMs were exempt from ACA insurance requirements (e.g., guaranteed coverage, no pre-existing condition exclusions) and faced minimal federal oversight beyond basic tax rules. The act introduces mandatory disclosures and reporting without altering HCSM exemptions or imposing insurance regulations, but it borrows concepts like medical loss ratios and penalty structures from existing ACA provisions.

Potential Impacts

• On Government Agencies: Increases workload for HHS (reporting, publication, enforcement), IRS and CFPB (receiving data for potential tax or financial oversight), and FTC (handling and reporting complaints). This could improve coordination on consumer protection but may require new resources for data management and investigations.

• On Citizens: Empowers individuals, especially those considering HCSMs as a cheaper alternative to insurance, by providing clear risks (e.g., no reimbursement guarantees, high denial rates). It may reduce surprises like unpaid claims, encourage more to opt for regulated insurance with protections, and highlight eligibility for subsidies or public programs. Low-income or vulnerable groups could benefit from broker explanations of alternatives.

• On International Relations: No direct impact, as the bill focuses on domestic health cost-sharing arrangements.

Main Stakeholders Affected

• Health Care Sharing Ministries: Face new compliance burdens, including reporting and disclosures, which could increase operational costs but promote legitimacy.
• Current and Prospective Members: Gain better information to evaluate options, potentially leading to more informed choices and fewer financial hardships from unexpected denials.
• Enrollment Entities (e.g., Brokers or Agents): Must provide balanced comparisons to government programs and insurance, limiting aggressive marketing of HCSMs.
• Government Agencies (HHS, IRS, CFPB, FTC): Take on oversight roles to monitor transparency and complaints.
• Health Care Providers: May see indirect effects if contracted with HCSMs, through required listings that could influence enrollment patterns.
• Broader Consumers: Benefits from public data and complaint tracking, aiding awareness of HCSM reliability.

Notable Legal, Constitutional, or Political Implications

• Legal: Strengthens consumer protection by mandating disclosures similar to those for financial products, with enforceable penalties tied to existing ACA frameworks. It clarifies HCSMs are not insurance, potentially reducing lawsuits over misrepresentations, but allows HHS flexibility in definitions, which could lead to future rulemaking challenges.

• Constitutional: Likely withstands scrutiny, as it regulates commercial speech (disclosures in business contexts) without broadly restricting free exercise of religion—HCSMs remain operational. However, faith-based groups might argue it burdens religious practices, though the bill targets transparency, not beliefs.

• Political: Addresses growing concerns about HCSMs marketing themselves as insurance alternatives amid rising health costs, without banning them (appealing to bipartisan consumer advocates). It could spark debate over ACA expansions versus religious freedoms, influencing future health policy on unregulated alternatives.

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

Sponsor

Rep. Huffman, Jared [D-CA-2]

Cosponsors (8)

Rep. Raskin, Jamie [D-MD-8], Rep. Casten, Sean [D-IL-6], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Tlaib, Rashida [D-MI-12], Rep. Pocan, Mark [D-WI-2], Rep. Moulton, Seth [D-MA-6], Rep. Cohen, Steve [D-TN-9], Rep. Frost, Maxwell [D-FL-10]

Recent Actions

• 2025-04-30: Referred to the House Committee on Energy and Commerce.
• 2025-04-30: Introduced in House
• 2025-04-30: Introduced in House

Bill Versions

• Health Share Transparency Act of 2025 — issued 2025-04-30 — PDF (10 pages)