American Citizenship Healthcare Integrity Act of 2025

Bill Number

H.R. 6801

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-12-17: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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

2026-01-22T15:20:03Z

AI-Generated Summary

Purpose

The "American Citizenship Healthcare Integrity Act of 2025" (H.R. 6801) aims to ensure that hospitals participating in the Medicare program collect information on patients' citizenship status. This is intended to track and report the costs of healthcare services provided to noncitizens, highlighting uncompensated care (services not paid for by patients or insurers) and its impact on federal spending.

Key Provisions

• Citizenship Inquiry Requirement: Starting 180 days after the bill's enactment, hospitals, critical access hospitals, and rural emergency hospitals must include a question on patient intake forms (or equivalents) asking if the individual is a U.S. citizen or national.
• Annual Reporting by Hospitals: Beginning one year after enactment and annually thereafter, these facilities must submit reports to the Secretary of Health and Human Services (HHS) detailing:
• The number of noncitizens (individuals who are not U.S. citizens or nationals) who received services in the previous year.
• The dollar amount of uncompensated care provided to those noncitizens.
• Public Report by HHS Secretary: Starting one year after enactment and annually thereafter, the Secretary must publish a report on:
• The total uncompensated care costs for noncitizens across all affected hospitals, based on hospital submissions.
• An estimate of federal expenditures under Medicare (Title XVIII of the Social Security Act) and Medicaid (Title XIX) that would not have occurred without this uncompensated care.

These requirements are added as a condition for hospitals to participate in Medicare, meaning non-compliance could jeopardize their program eligibility.

Significant Changes to Existing Law

• Amends Section 1866(a)(1) of the Social Security Act by adding a new subparagraph (Z), which introduces the citizenship question and hospital reporting obligations as mandatory provider agreements.
• Adds a new subsection (l) to Section 1866, requiring the HHS Secretary to compile and publicize aggregate data on uncompensated care for noncitizens and its federal cost implications.
• No prior federal mandate existed for hospitals to routinely ask about citizenship status on intake forms or to report such data specifically for noncitizens in the Medicare context.

Potential Impacts

• On Government Agencies: The Centers for Medicare & Medicaid Services (CMS, part of HHS) will face increased administrative duties for collecting, verifying, and analyzing hospital reports, potentially leading to higher operational costs and new data management systems.
• On Citizens and Healthcare Providers: U.S. citizens may experience minor changes to intake processes, but the main effect could be on noncitizen patients, who might hesitate to seek care due to the citizenship question, potentially delaying treatment. Hospitals could incur added costs for form updates, staff training, and reporting.
• On Federal Budget and Taxpayers: The reports could inform future policy on healthcare funding for noncitizens, possibly influencing budget allocations for Medicare and Medicaid by quantifying uncompensated care costs (estimated federal "savings" if such care were avoided).
• On International Relations: Minimal direct impact, though the focus on noncitizens could draw scrutiny from countries with significant immigrant populations to the U.S., potentially affecting diplomatic discussions on migration and health.

Main Stakeholders Affected

• Hospitals and Healthcare Providers: All Medicare-participating hospitals, including critical access and rural emergency facilities, must comply with new intake and reporting rules.
• Noncitizen Patients: Undocumented immigrants, legal noncitizens (e.g., visa holders), and others without U.S. citizenship may be directly questioned and tracked, affecting their access to emergency and other hospital services.
• U.S. Government Entities: HHS and CMS will oversee implementation and reporting; Congress and federal budget planners could use the data for oversight.
• Taxpayers and Citizens: Indirectly affected through potential insights into federal healthcare spending on noncitizens, which might influence public discourse on immigration and entitlement programs.

Notable Legal, Constitutional, or Political Implications

• Legal: The bill ties compliance to Medicare participation, which could lead to enforcement actions (e.g., loss of funding) for non-compliant hospitals. It raises questions about data privacy under laws like HIPAA (Health Insurance Portability and Accountability Act, which protects patient information), as citizenship data must be collected and shared with the government.
• Constitutional: Potential challenges under the Equal Protection Clause of the 14th Amendment if the requirements disproportionately burden noncitizens' access to emergency care, which is guaranteed under the Emergency Medical Treatment and Labor Act (EMTALA). However, the bill does not explicitly deny care based on citizenship.
• Political: Reinforces debates on immigration enforcement and healthcare costs, positioning it as a tool for transparency on federal spending. As introduced by Representatives Mace and Boebert, it aligns with efforts to address perceived fiscal burdens of noncitizen healthcare, but could polarize views on equity in public health programs.

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

Sponsor

Rep. Mace, Nancy [R-SC-1]

Cosponsors (1)

Rep. Boebert, Lauren [R-CO-4]

Recent Actions

• 2025-12-17: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
• 2025-12-17: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
• 2025-12-17: Introduced in House
• 2025-12-17: Introduced in House

Bill Versions

• American Citizenship Healthcare Integrity Act of 2025 — issued 2025-12-17 — PDF (4 pages)