More Affordable Care Act
- Bill Number
- H.R. 6538
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-12-09: 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
- 2026-01-07T16:44:05Z
AI-Generated Summary
More Affordable Care Act (H.R. 6538)
Purpose
This legislation establishes a state-level health freedom waiver program under the Patient Protection and Affordable Care Act (ACA), creates alternative funding mechanisms through Trump Health Freedom Accounts, expands small employer tax credits in participating states, and directs federal agencies to strengthen price transparency and outcomes reporting requirements.
Key Provisions
- Health Freedom Waiver Program (Section 2): Adds Section 1335 to the ACA, permitting states to notify the Secretary of Health and Human Services or Treasury of intent to waive requirements in Parts 1 and 2 of Subtitle D, Section 1402 (cost-sharing reductions), and Internal Revenue Code Sections 36B and 5000A. States must maintain a high-risk insurance pool or similar risk-mitigation program. Waivers take effect January 1, 2026, and continue until revoked.
- Money Follows the Person and Trump Health Freedom Accounts (Sections 2 and 3): Redirects aggregate premium tax credits and cost-sharing reductions to individual Trump Health Freedom Accounts (a type of health savings account) for eligible residents in waived states, calculated using national average silver-plan premiums. Accounts allow purchase of authorized plans, permit rollovers from existing HSAs, and prohibit use for gender transition procedures or abortion services, with detailed statutory definitions and exclusions for certain medical conditions.
- Exchange Options (Section 2): States may operate their own exchanges, authorize private commercial platforms, or default to a federal exchange subject to state laws. An application program interface must be made available for commercial platforms.
- Small Employer Credit (Section 4): Amends Internal Revenue Code Section 45R to provide a 50% credit for small employers (up to 50 employees) in waived states, removes the phaseout, extends the credit period indefinitely, and treats state-authorized plans as qualified health plans.
- Price Reporting and Outcomes Data (Section 5): Requires the Secretaries of Health and Human Services, Treasury, and Labor to update regulations within 90 days to mandate disclosure of actual prices, standardize comparable data across hospitals and plans, strengthen enforcement, and require public reporting of provider outcomes data.
- Limitations: Waivers cannot extend to Title XXVII of the Public Health Service Act (including pre-existing condition protections). Child-only plans may be offered in waived states.
Significant Changes to Existing Law
- Creates a new state opt-out mechanism that bypasses core ACA insurance market rules and federal subsidies while redirecting equivalent funding to restricted health savings accounts.
- Modifies health savings account rules under IRC Section 223 to include new eligibility, contribution treatment, and prohibited-use categories not present in current law.
- Expands and alters the small business health insurance tax credit under IRC Section 45R specifically for employers in participating states.
- Updates transparency rules originally issued under Executive Order 13877 to require actual prices and outcomes data rather than estimates.
Potential Impacts
- Government Agencies: Increases administrative responsibilities for the Department of Health and Human Services and Department of the Treasury in processing waivers, calculating and distributing account payments, coordinating waiver processes with existing programs, and revising regulations.
- Citizens: Residents of participating states may access alternative plan options and redirected funds through Trump Health Freedom Accounts but lose eligibility for standard ACA tax credits and cost-sharing reductions; restrictions apply to certain medical services.
- International Relations: No direct provisions or anticipated effects.
Main Stakeholders Affected
- State governments (governors or legislatures deciding on waivers)
- Health insurance issuers and providers operating in participating states
- Individuals and small employers residing or located in waived states
- Federal agencies responsible for ACA implementation and tax administration
Notable Legal, Constitutional, or Political Implications
- Raises questions regarding the scope of federal waiver authority and potential challenges to the redirection of appropriated funds through executive action.
- Introduces statutory definitions and restrictions on gender transition procedures and abortion services within tax-advantaged accounts, which may intersect with existing federal and state laws on medical coverage.
- Establishes a coordinated waiver process across multiple federal health programs without altering core consumer protections under the Public Health Service Act.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Pfluger, August [R-TX-11]
Cosponsors (5)
Rep. Bean, Aaron [R-FL-4], Rep. Fedorchak, Julie [R-ND-At Large], Rep. Baird, James R. [R-IN-4], Rep. Clyde, Andrew S. [R-GA-9], Rep. Goldman, Craig A. [R-TX-12]
Recent Actions
- 2025-12-09: 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.
- 2025-12-09: 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.
- 2025-12-09: Introduced in House
- 2025-12-09: Introduced in House
Bill Versions
- More Affordable Care Act — issued 2025-12-09 — PDF (21 pages)