Lower Health Care Premiums for All Americans Act

Bill Number: H.R. 6703
Origin Chamber: House
Congress: 119th Congress, Session 1
Policy Area: Health
Status: Passed House
Latest Action: 2025-12-18: Received in the Senate.
Last Updated: 2026-04-03T15:39:48Z

AI-Generated Summary

Purpose of the Legislation

The Lower Health Care Premiums for All Americans Act (H.R. 6703) seeks to make health insurance more affordable and accessible by expanding options for group health plans, clarifying rules for certain insurance arrangements, increasing transparency in pharmacy benefits, and providing funding for cost-sharing reductions under the Affordable Care Act (ACA). It focuses on reducing premiums for workers, self-employed individuals, and others through market-based changes rather than new mandates.

Key Provisions

Association Health Plans (Title I, Sec. 101): Allows groups or associations of employers (not limited to the same industry) to create and maintain group health plans if they meet criteria such as:
Formed in good faith for non-insurance purposes, with a formal structure (e.g., governing board and bylaws) controlled by at least 75% employer members.
Existing for at least 2 years before offering coverage.
Covering at least 51 employees (or 20 self-employed individuals aggregated as one group) and making coverage available to all eligible employees and dependents.
Prohibits discrimination based on health status (e.g., pre-existing conditions) and ensures equal premium contributions for similar individuals.
For self-employed-only groups, treats all as a single risk pool with uniform premiums.
Premiums can use a community rating adjusted by employer risk profiles, subject to state law.
Self-employed individuals (those without employees, owning a business, earning income, and working 10+ hours/week) are treated as both employers and employees.
Does not create joint employer status under labor laws and does not exempt plans from other federal health protections.

Stop-Loss Insurance for Self-Insured Plans (Title I, Sec. 102): Excludes stop-loss insurance (policies that reimburse self-insured plans for high claims above a set threshold) from the federal definition of "health insurance coverage." This preempts state laws that block such insurance, allowing more self-insured plans to manage risks.

Custom Health Option and Individual Care Expense Arrangements (CHOICE HRAs) (Title I, Sec. 103): Defines a new type of employer-funded health reimbursement arrangement (HRA) integrated with individual market coverage or Medicare Parts A/B/C. Key rules:
Funded only by employers up to a fixed annual amount; reimburses medical expenses only while the individual has qualifying coverage.
Must be non-discriminatory (offered equally within employee classes like full-time or part-time workers; allows age-based increases up to 300% of base).
Requires substantiation of coverage enrollment and proper expense claims.
Provides 60-day advance written notice to employees explaining rights/obligations.
Treated as compliant with ACA nondiscrimination, preventive care, and other rules.
Employees in these HRAs can use cafeteria plans (Section 125) to buy exchange insurance.
Employers must report total benefits on W-2 forms.
Effective for plan years beginning after December 31, 2025.

Oversight of Pharmacy Benefit Managers (PBMs) (Title II, Sec. 201): Requires PBMs (entities managing drug benefits for plans/insurers) to submit semi-annual reports (or quarterly if requested) to group health plans on drug spending. Reports must be in plain, machine-readable format and include:
For large plans (100+ employees/participants): Detailed per-drug data (e.g., compensation paid to PBMs/pharmacies, differences in payments, National Drug Codes, dispensing channels, brand/generic status, out-of-pocket costs, net prices after rebates, total spending, copay assistance).
Therapeutic class summaries (e.g., gross/net spending, rebates, formulary details, utilization controls like prior authorization).
High-cost drugs (> $10,000 gross spending or top 50): Rationale for placement and changes.
Affiliated pharmacies: Pricing comparisons, incentives for mail-order/specialty use.
For all plans: Aggregate summaries on total spending, rebates, broker fees, and benefit designs steering to affiliated pharmacies.
Plans must notify participants annually and provide summaries/claim details on request.
Contracts with drug makers, wholesalers, etc., cannot block disclosure.
Privacy protections align with HIPAA (uses summary health info only; limits sharing).
Enforcement: $10,000/day civil penalties for non-reporting; up to $100,000 per false item. Waivers for good-faith efforts. Secretary (HHS) sets standards within 18 months; aligns with existing reporting rules.
Effective 30 months after enactment; limited reports for plans tied to drug supply chain to avoid anti-competitive issues.

Funding for Cost-Sharing Reductions (Title II, Sec. 202): Permanently appropriates Treasury funds for ACA cost-sharing reduction (CSR) payments to insurers offering silver plans to low-income enrollees (reducing deductibles/copays). Starts January 1, 2027. Prohibits funds for plans covering abortions, except when necessary to save the mother's life or in cases of rape/incest.

Significant Changes to Existing Law

ERISA (Employee Retirement Income Security Act): Broadens "employer" definition to include diverse associations; adds stop-loss exemption and preemption; introduces CHOICE HRAs and PBM reporting; enhances fiduciary duties for eligibility verification.
Public Health Service Act (PHSA) and Internal Revenue Code (IRC): Mirrors ERISA changes for consistency across group plans; adds PBM transparency not previously required at this level; allows HRAs to integrate with individual coverage (expanding 2019 rules) and permits exchange purchases via cafeteria plans (previously restricted).
ACA (Patient Protection and Affordable Care Act): Provides explicit, ongoing funding for CSRs (previously funded via insurer risk adjustments after 2017 withholding); adds abortion funding limits, differing from ACA's broader allowances.
No changes to individual mandate or essential benefits; preserves protections against pre-existing condition discrimination.

Potential Impacts

Government Agencies: HHS, DOL, and Treasury gain enforcement roles (e.g., penalties, rulemaking for PBM formats/privacy); increased oversight could raise administrative costs but improve drug pricing transparency. CSR funding shifts costs to general Treasury funds, potentially stabilizing ACA marketplaces.
Citizens: Self-employed and small employers may access cheaper group rates via associations/HRAs, lowering premiums. Participants gain drug cost insights (e.g., rebates, pharmacy steering), possibly reducing out-of-pocket expenses. Low-income ACA enrollees benefit from funded CSRs, avoiding premium hikes on silver plans. However, abortion restriction may limit plan choices for some.
International Relations: No direct impact; focuses on domestic insurance markets.

Main Stakeholders Affected

Employers/Self-Employed: Gain flexibility for pooled plans and HRAs; must comply with new governance/nondiscrimination rules.
Employees/Beneficiaries: Benefit from affordable options and PBM transparency; can request drug info for better decisions.
Health Plans/Insurers: Face competition from associations; must integrate CHOICE HRAs and handle CSR funds with restrictions.
PBMs/Pharmacy Benefit Entities: New reporting burdens; potential exposure of rebate/pricing practices, affecting profits.
Pharmacies/Drug Makers/Wholesalers: Increased scrutiny on affiliations, rebates, and copay assistance; may alter contracting.
Plan Sponsors/Fiduciaries: Responsible for verification, notices, and using reports to select PBMs.

Notable Legal, Constitutional, or Political Implications

Legal: ERISA preemption of state stop-loss/association rules may invite lawsuits over federal overreach (similar to past challenges). PBM reporting must balance transparency with HIPAA privacy; enforcement via civil penalties (up to $100,000) strengthens federal tools without new agencies. CHOICE HRAs build on 2019 regs but add specifics, potentially reducing litigation over HRA-ACA compliance.
Constitutional: Preemption raises federalism concerns (states' rights to regulate insurance), but aligns with ERISA's commerce clause authority. Abortion funding limit may face equal protection challenges under the 14th Amendment, echoing Hyde Amendment precedents.
Political: Promotes market competition to cut premiums (e.g., associations echo 2018 rules), appealing to business interests; PBM oversight targets drug costs without price controls. CSR funding resolves 2017-2024 disputes but adds partisan abortion rider, potentially dividing support along reproductive rights lines. Overall, neutralizes some ACA criticisms while avoiding expansions.

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

Sponsor

Rep. Miller-Meeks, Mariannette [R-IA-1]

Recent Actions

2025-12-18: Received in the Senate.
2025-12-17: Motion to reconsider laid on the table Agreed to without objection.
2025-12-17: On passage Passed by the Yeas and Nays: 216 - 211 (Roll no. 349). (text: CR H5956-5966) (Roll call 349)
2025-12-17: Passed/agreed to in House: On passage Passed by the Yeas and Nays: 216 - 211 (Roll no. 349). (Roll call 349)
2025-12-17: On motion to recommit Failed by the Yeas and Nays: 210 - 218 (Roll no. 348). (Roll call 348)
2025-12-17: Considered as unfinished business. (consideration: CR H6006-6008)
2025-12-17: POSTPONED PROCEEDINGS - At the conclusion of debate on H.R. 6703, the Chair put the question on motion to recommit and by voice vote, announced the noes had prevailed. Ms. Underwood demanded the yeas and nays and the Chair postponed further proceedings until a time to be announced.
2025-12-17: The previous question on the motion to recommit was ordered pursuant to clause 2(b) of rule XIX.
2025-12-17: Ms. Underwood moved to recommit to the Committee on Energy and Commerce. (text: CR H5977)
2025-12-17: The previous question was ordered pursuant to the rule.
2025-12-17: DEBATE - The House proceeded with one hour of debate on H.R. 6703.
2025-12-17: Rule provides for consideration of H.R. 6703, H.R. 498 and H.R. 3492. The resolution provides for consideration of H.R. 6703 and H.R. 498 under a closed rule and H.R. 3492 under a structured rule with one hour of general debate and one motion to recommit on each bill.
2025-12-17: Considered under the provisions of rule H. Res. 953. (consideration: CR H5956-5977)
2025-12-17: Rules Committee Resolution H. Res. 953 Reported to House. Rule provides for consideration of H.R. 6703, H.R. 498 and H.R. 3492. The resolution provides for consideration of H.R. 6703 and H.R. 498 under a closed rule and H.R. 3492 under a structured rule with one hour of general debate and one motion to recommit on each bill.
2025-12-15: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and 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.

Bill Versions

Lower Health Care Premiums for All Americans Act — issued 2025-12-17 — PDF (112 pages)
Lower Health Care Premiums for All Americans Act — issued 2025-12-15 — PDF (111 pages)