Protect Patients from Costly Care Act
- Bill Number
- H.R. 5094
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-09-02: 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.
- Last Updated
- 2025-12-05T22:53:36Z
AI-Generated Summary
Purpose of the Legislation
The "Protect Patients from Costly Care Act" (H.R. 5094) aims to reverse specific modifications made to Medicaid (a federal-state health program for low-income individuals) cost-sharing rules and to the Medicare Drug Price Negotiation Program's treatment of orphan drugs (medications for rare diseases affecting fewer than 200,000 people in the U.S.). By repealing these changes from a prior reconciliation law (Public Law 119-21), the bill seeks to restore the original legal framework, potentially reducing financial burdens on patients and limiting government interventions in drug pricing for rare conditions.
Key Provisions
- Short Title: The bill is titled the "Protect Patients from Costly Care Act."
- Repeal of Medicaid Cost-Sharing Changes (Section 2):
- Fully repeals Section 71120 of Public Law 119-21, which had altered how states can require Medicaid enrollees to share costs (e.g., copayments or deductibles for services).
- Restores Title XIX of the Social Security Act (the legal basis for Medicaid) to its pre-amendment state, as if the changes never occurred.
- Rescinds (cancels) any funds appropriated under the repealed section for implementing these changes.
- Repeal of Orphan Drug Exclusion Changes (Section 3):
- Fully repeals Section 71203 of Public Law 119-21, which had modified the exclusion of orphan drugs from Medicare's drug price negotiation process (a program allowing the government to negotiate lower prices for high-cost Medicare drugs).
- Restores Title XI of the Social Security Act (covering Medicare provisions) to its pre-amendment state.
Significant Changes to Existing Law
- This bill introduces no new rules but instead undoes recent amendments from Public Law 119-21 (enacted as part of a 2025 budget reconciliation process).
- For Medicaid: Reverses expansions or adjustments to cost-sharing limits, reverting to stricter federal protections that cap out-of-pocket costs for low-income beneficiaries (e.g., preventing states from imposing higher fees that could deter care access).
- For Medicare: Restores the broader exclusion of orphan drugs from price negotiations, meaning these drugs would again be exempt from government-mandated price reductions, potentially preserving higher prices to encourage rare disease research.
Potential Impacts
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) would need to update regulations and systems to revert to prior rules, possibly saving administrative costs from the rescinded appropriations but requiring effort to implement the rollback. States managing Medicaid programs could regain flexibility in cost-sharing but face renewed federal oversight.
- On Citizens: Medicaid enrollees, particularly low-income families and individuals with disabilities, may benefit from restored limits on out-of-pocket costs, reducing barriers to care. Patients with rare diseases relying on orphan drugs could see stable access without price cuts affecting availability, though Medicare beneficiaries might face higher overall drug costs if negotiations are limited.
- On International Relations: Minimal direct impact, as the bill focuses on domestic health programs; however, it could indirectly influence U.S. pharmaceutical trade by maintaining incentives for orphan drug development, which often involves global companies.
Main Stakeholders Affected
- Medicaid Beneficiaries: Low-income individuals, children, seniors, and people with disabilities who could avoid increased cost-sharing burdens.
- Patients with Rare Diseases: Those using orphan drugs, who might benefit from preserved pricing that supports drug availability.
- Pharmaceutical Companies: Manufacturers of orphan drugs gain from the restored exclusion, potentially boosting investment in rare disease treatments; broader drug makers may see varied effects on Medicare negotiations.
- State Governments: Gain or lose flexibility in Medicaid funding and administration depending on prior reliance on the repealed changes.
- Federal Health Programs: Medicare and Medicaid administrators, including CMS, affected by policy reversals and funding rescissions.
Notable Legal, Constitutional, or Political Implications
- Legal: The repeals use standard congressional authority to amend prior laws via the Social Security Act, ensuring continuity without creating new entitlements. The rescission of appropriations aligns with Congress's power of the purse under Article I of the U.S. Constitution, potentially facing challenges if seen as disrupting ongoing implementations.
- Constitutional: No direct conflicts, but it reinforces federalism in Medicaid by restoring state-federal balances; could invite lawsuits from drug makers or patient advocates if the rollback affects vested interests in pricing or access.
- Political: As a targeted repeal of provisions from a recent reconciliation bill (often passed via budget rules to bypass filibusters), it highlights partisan divides on health care costs—sponsors (Democrats) frame it as patient protection, while it may draw opposition from those favoring cost controls. Referred to key committees (Energy and Commerce, Ways and Means), passage would require majority support in a divided Congress.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (9)
Rep. Jackson, Jonathan L. [D-IL-1], Rep. Ruiz, Raul [D-CA-25], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Fields, Cleo [D-LA-6], Rep. Larson, John B. [D-CT-1], Rep. Carson, André [D-IN-7], Rep. Thanedar, Shri [D-MI-13], Rep. Craig, Angie [D-MN-2], Rep. Goodlander, Maggie [D-NH-2]
Recent Actions
- 2025-09-02: 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.
- 2025-09-02: 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.
- 2025-09-02: Introduced in House
- 2025-09-02: Introduced in House
Bill Versions
- Protect Patients from Costly Care Act — issued 2025-09-02 — PDF (2 pages)